Provider Demographics
NPI:1407852361
Name:ELWERT, JEFFREY C (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:ELWERT
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:PO BOX 428668
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8668
Mailing Address - Country:US
Mailing Address - Phone:513-922-2204
Mailing Address - Fax:513-922-2009
Practice Address - Street 1:3328 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5133
Practice Address - Country:US
Practice Address - Phone:513-922-2204
Practice Address - Fax:513-922-2009
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435729Medicaid
OHP00988424OtherRR MEDICARE
OHEL0479013Medicare PIN
OHT47149Medicare UPIN