Provider Demographics
NPI:1497893606
Name:ELLIOTT, MICHAEL TODD (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
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 1:615 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-3010
Mailing Address - Country:US
Mailing Address - Phone:865-988-9815
Mailing Address - Fax:865-988-9816
Practice Address - Street 1:615 E BDWY
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-3010
Practice Address - Country:US
Practice Address - Phone:865-988-9815
Practice Address - Fax:865-988-9816
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN01817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01817OtherTN MEDICAL LICENSE
TN01817OtherTN MEDICAL LICENSE