Provider Demographics
NPI:1164569778
Name:ELWER, DIANE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LYNN
Last Name:ELWER
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 1:716 W BROOKSIDE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2073
Mailing Address - Country:US
Mailing Address - Phone:719-475-9103
Mailing Address - Fax:719-475-2225
Practice Address - Street 1:716 W BROOKSIDE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2073
Practice Address - Country:US
Practice Address - Phone:719-475-9103
Practice Address - Fax:719-475-2225
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807625Medicare PIN
COV11531Medicare UPIN