Provider Demographics
NPI:1164513826
Name:ELFMAN, MARK S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ELFMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035
Mailing Address - Country:US
Mailing Address - Phone:508-543-0764
Mailing Address - Fax:508-543-0765
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:508-543-0764
Practice Address - Fax:508-543-0765
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609238Medicaid
MAY35941OtherBCBS
MAY35941Medicare ID - Type Unspecified
MA1609238Medicaid