Provider Demographics
NPI:1598743528
Name:ELGATIAN, LEO LEVON (DC)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:LEVON
Last Name:ELGATIAN
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 1:2209 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5258
Mailing Address - Country:US
Mailing Address - Phone:563-264-8825
Mailing Address - Fax:563-264-0869
Practice Address - Street 1:2209 2ND AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5258
Practice Address - Country:US
Practice Address - Phone:563-264-8825
Practice Address - Fax:563-264-0869
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor