Provider Demographics
NPI:1558853952
Name:NORTHEN, ELENA RENEE (DC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:RENEE
Last Name:NORTHEN
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 1:1940 E 18TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1108
Mailing Address - Country:US
Mailing Address - Phone:720-398-2050
Mailing Address - Fax:
Practice Address - Street 1:1940 E 18TH AVE STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1108
Practice Address - Country:US
Practice Address - Phone:720-398-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor