Provider Demographics
NPI:1588844773
Name:ELDER CHIROPRACTIC OFFICES LTD.
Entity Type:Organization
Organization Name:ELDER CHIROPRACTIC OFFICES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-867-3558
Mailing Address - Street 1:119 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1253
Mailing Address - Country:US
Mailing Address - Phone:507-867-3558
Mailing Address - Fax:
Practice Address - Street 1:119 MAIN ST S
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1253
Practice Address - Country:US
Practice Address - Phone:507-867-3558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDER CHIROPRACTIC OFFICES LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-06
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001873261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4948271Medicaid
MN39251ELOtherBLUECROSS AND BLUESHIELD
MN39251ELOtherBLUECROSS AND BLUESHIELD