Provider Demographics
NPI:1497870760
Name:ELLIOTT, LORI ARLENE (D C)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ARLENE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 S 20TH STREET CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1407
Mailing Address - Country:US
Mailing Address - Phone:402-421-1762
Mailing Address - Fax:
Practice Address - Street 1:735 S 56TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3960
Practice Address - Country:US
Practice Address - Phone:402-489-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076512300Medicaid
NE09765OtherBLUE CROSS BLUE SHIELD