Provider Demographics
NPI:1407463219
Name:SOUDERS, ELIJAH CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:CHRISTOPHER
Last Name:SOUDERS
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 1:172 TOULOUSE LANE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403
Mailing Address - Country:US
Mailing Address - Phone:240-362-1309
Mailing Address - Fax:
Practice Address - Street 1:36 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1415
Practice Address - Country:US
Practice Address - Phone:240-343-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor