Provider Demographics
NPI:1164440210
Name:ELLIOTT, MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 SE CARY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7419
Mailing Address - Country:US
Mailing Address - Phone:919-461-8400
Mailing Address - Fax:
Practice Address - Street 1:930 SE CARY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7419
Practice Address - Country:US
Practice Address - Phone:919-461-8400
Practice Address - Fax:919-461-2380
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085EGMedicaid
NC89085EGMedicaid
NC89085EGMedicaid