Provider Demographics
NPI:1275638686
Name:ELI, ROCKNE K
Entity Type:Individual
Prefix:DR
First Name:ROCKNE
Middle Name:K
Last Name:ELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 E MAIN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3132
Mailing Address - Country:US
Mailing Address - Phone:253-848-2244
Mailing Address - Fax:253-848-1337
Practice Address - Street 1:1203 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3132
Practice Address - Country:US
Practice Address - Phone:253-848-2244
Practice Address - Fax:253-848-1337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5877ELOtherBLUE CROSS BLUE SHIELD
WA912047546OtherBLUE CROSS
WA0146161OtherLABOR AND INDUSTRIES
WA912047546OtherEMPLOYER TIN
WA912047546OtherEMPLOYER TIN
WA912047546OtherBLUE CROSS