Provider Demographics
NPI:1417975657
Name:ELLIOTT, ROBERT M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:5700 WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7811
Mailing Address - Country:US
Mailing Address - Phone:423-238-4200
Mailing Address - Fax:423-238-4206
Practice Address - Street 1:5700 WATKINS ST
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7811
Practice Address - Country:US
Practice Address - Phone:423-238-4200
Practice Address - Fax:423-238-4206
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN367-8859Medicaid
TN3033549OtherBCBS
TN3033549OtherBCBS
TN367-8859Medicare ID - Type Unspecified