Provider Demographics
NPI:1417172255
Name:COHEN, NATHAN ELLIOT (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ELLIOT
Last Name:COHEN
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 788
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140-0788
Mailing Address - Country:US
Mailing Address - Phone:530-583-1609
Mailing Address - Fax:
Practice Address - Street 1:3190 FABIAN WAY,
Practice Address - Street 2:SUITE B
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140-0788
Practice Address - Country:US
Practice Address - Phone:530-583-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89468Medicare UPIN