Provider Demographics
NPI:1407334592
Name:ELLIOTT, NATHAN LEROY (DC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:LEROY
Last Name:ELLIOTT
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 1:923 E. COLBY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1203
Mailing Address - Country:US
Mailing Address - Phone:231-893-1744
Mailing Address - Fax:231-893-6637
Practice Address - Street 1:923 E. COLBY RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1203
Practice Address - Country:US
Practice Address - Phone:231-893-1744
Practice Address - Fax:231-893-6637
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor