Provider Demographics
NPI:1477972362
Name:ELEMENTAL BACK & BODY
Entity Type:Organization
Organization Name:ELEMENTAL BACK & BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-582-0500
Mailing Address - Street 1:10049 MARTIS VALLEY RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0543
Mailing Address - Country:US
Mailing Address - Phone:530-582-0500
Mailing Address - Fax:530-582-0500
Practice Address - Street 1:10049 MARTIS VALLEY RD
Practice Address - Street 2:UNIT E
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0543
Practice Address - Country:US
Practice Address - Phone:530-582-0500
Practice Address - Fax:530-582-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31591111N00000X
CA14604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty