Provider Demographics
NPI:1578885737
Name:ELLIOTT, AMY A (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:A
Last Name:ELLIOTT
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 1:530 N 108TH PL
Mailing Address - Street 2:STE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4253
Mailing Address - Country:US
Mailing Address - Phone:414-897-7078
Mailing Address - Fax:888-656-9811
Practice Address - Street 1:530 N 108TH PL
Practice Address - Street 2:STE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4253
Practice Address - Country:US
Practice Address - Phone:414-897-7078
Practice Address - Fax:888-656-9811
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4592-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor