Provider Demographics
NPI:1346360062
Name:ELLER, ALETHEA (DC)
Entity Type:Individual
Prefix:DR
First Name:ALETHEA
Middle Name:
Last Name:ELLER
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 1:49 N GORE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2357
Mailing Address - Country:US
Mailing Address - Phone:314-219-1888
Mailing Address - Fax:
Practice Address - Street 1:49 N GORE AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2357
Practice Address - Country:US
Practice Address - Phone:314-219-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88412Medicare UPIN
MO000031966Medicare ID - Type Unspecified
U88412Medicare UPIN
MO4400977OtherUNITED HEALTHCARE
MO477316OtherHEALTHLINK
MO192093OtherGHP
MO0010769001OtherCIGNA