Provider Demographics
NPI:1609947654
Name:ELLIOTT, JOHANNA A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
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 1:101 HWY 21 EAST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836
Mailing Address - Country:US
Mailing Address - Phone:979-567-7001
Mailing Address - Fax:979-567-0981
Practice Address - Street 1:101 HWY 21 E
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836
Practice Address - Country:US
Practice Address - Phone:979-567-7001
Practice Address - Fax:979-567-0981
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603586Medicare ID - Type Unspecified
U29285Medicare UPIN