Provider Demographics
NPI:1467467134
Name:VITKOFF, ELAN (DC)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:
Last Name:VITKOFF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1607
Mailing Address - Country:US
Mailing Address - Phone:415-781-1131
Mailing Address - Fax:415-781-2108
Practice Address - Street 1:396 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1607
Practice Address - Country:US
Practice Address - Phone:415-781-1131
Practice Address - Fax:415-781-2108
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 13703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0137030Medicare ID - Type UnspecifiedMEDICARE #