Provider Demographics
NPI:1417278433
Name:ELLIOTT CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:ELLIOTT CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-966-2700
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-0520
Mailing Address - Country:US
Mailing Address - Phone:360-966-2700
Mailing Address - Fax:360-966-2701
Practice Address - Street 1:111 E.MAIN STREET
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247
Practice Address - Country:US
Practice Address - Phone:360-966-2700
Practice Address - Fax:360-966-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 00002047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002442Medicaid
WA2002442Medicaid