Provider Demographics
NPI:1629029046
Name:ACUNA-TINDALL, ELIA (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIA
Middle Name:
Last Name:ACUNA-TINDALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIA
Other - Middle Name:
Other - Last Name:ACUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:P.O. BOX 628
Mailing Address - Street 2:111 E. INDIANA AVE.
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-0628
Mailing Address - Country:US
Mailing Address - Phone:419-740-3099
Mailing Address - Fax:419-740-3095
Practice Address - Street 1:111 E. INDIANA AVE.
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-0628
Practice Address - Country:US
Practice Address - Phone:419-740-3099
Practice Address - Fax:419-740-3095
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004757111N00000X, 111NN1001X
OHDC-04894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E016250OtherBLUE CROSS/BLUE SHIELD
MI950E016250OtherBLUE CROSS/BLUE SHIELD