Provider Demographics
NPI:1508952169
Name:ELLIOTT, WILLIAM DEWAINE (D C)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DEWAINE
Last Name:ELLIOTT
Suffix:
Gender:M
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 1:3153 CAHABA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5246
Mailing Address - Country:US
Mailing Address - Phone:205-967-0280
Mailing Address - Fax:205-967-0408
Practice Address - Street 1:3153 CAHABA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5246
Practice Address - Country:US
Practice Address - Phone:205-967-0280
Practice Address - Fax:205-967-0408
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87413Medicare UPIN