Provider Demographics
NPI:1376815811
Name:ELLIOTT, KIRK L (LAC, DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 COTSWOLD LN
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2301
Mailing Address - Country:US
Mailing Address - Phone:610-585-8628
Mailing Address - Fax:
Practice Address - Street 1:417 COTSWOLD LN
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2301
Practice Address - Country:US
Practice Address - Phone:610-585-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist