Provider Demographics
NPI:1215229869
Name:STEPHEN W. ELDER D.C.ACHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:STEPHEN W. ELDER D.C.ACHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/TRES
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-395-1406
Mailing Address - Street 1:PO BOX 6248
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93386-6248
Mailing Address - Country:US
Mailing Address - Phone:661-395-1406
Mailing Address - Fax:661-395-1179
Practice Address - Street 1:2020 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-5006
Practice Address - Country:US
Practice Address - Phone:661-395-1406
Practice Address - Fax:661-395-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC013507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0135070Medicare PIN