Provider Demographics
NPI:1326187279
Name:ELROD, ALICE BAIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:BAIN
Last Name:ELROD
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:PO BOX 1924
Mailing Address - Street 2:ELROD CHIROPRACTIC
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-1924
Mailing Address - Country:US
Mailing Address - Phone:406-297-3422
Mailing Address - Fax:
Practice Address - Street 1:403 DEWEY AVE.
Practice Address - Street 2:ELROD CHIROPRACTIC
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917
Practice Address - Country:US
Practice Address - Phone:406-297-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT90-0005387OtherTAX ID
MT0000163982Medicaid
MT0000163995Medicaid
MT0000163982Medicaid