Provider Demographics
NPI:1396016408
Name:HLADIK, ELIZABETH ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:HLADIK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ROSE
Other - Last Name:FAVRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5 MC CREA RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9183
Mailing Address - Country:US
Mailing Address - Phone:518-335-6792
Mailing Address - Fax:
Practice Address - Street 1:19 HOMER AVE STE 1
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2066
Practice Address - Country:US
Practice Address - Phone:518-798-4322
Practice Address - Fax:518-743-8686
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor