Provider Demographics
NPI:1245387380
Name:ELLIOTT, DEBORAH (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
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 1:161 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1746
Mailing Address - Country:US
Mailing Address - Phone:740-288-7246
Mailing Address - Fax:740-286-5251
Practice Address - Street 1:161 PEARL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1746
Practice Address - Country:US
Practice Address - Phone:740-288-7246
Practice Address - Fax:740-286-5251
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2128781Medicaid
OH76852Medicare UPIN
OH2128781Medicaid