Provider Demographics
NPI:1336289354
Name:ELCENKO, NOBLE OZORY (DC)
Entity Type:Individual
Prefix:
First Name:NOBLE
Middle Name:OZORY
Last Name:ELCENKO
Suffix:
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 1:1980 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2504
Mailing Address - Country:US
Mailing Address - Phone:925-685-8223
Mailing Address - Fax:925-685-5784
Practice Address - Street 1:1980 BEACH ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2504
Practice Address - Country:US
Practice Address - Phone:925-685-8223
Practice Address - Fax:925-685-5754
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24983ZMedicare ID - Type UnspecifiedGROUP NUMBER