Provider Demographics
NPI:1235414764
Name:POWELL, ELTON JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ELTON
Middle Name:
Last Name:POWELL
Suffix:JR
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 1:1395 CROSS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3729
Mailing Address - Country:US
Mailing Address - Phone:850-402-9060
Mailing Address - Fax:850-402-9063
Practice Address - Street 1:1395 CROSS CREEK CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3729
Practice Address - Country:US
Practice Address - Phone:850-402-9060
Practice Address - Fax:850-402-9063
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11788111N00000X
FLCH10308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor