Provider Demographics
NPI:1629043062
Name:ELLIOTT, NEIL L (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:L
Last Name:ELLIOTT
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 1:2104 W OAKTON
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1820
Mailing Address - Country:US
Mailing Address - Phone:847-692-6956
Mailing Address - Fax:847-692-9651
Practice Address - Street 1:2104 W OAKTON
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1820
Practice Address - Country:US
Practice Address - Phone:847-692-6956
Practice Address - Fax:847-692-9651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL678080Medicare ID - Type Unspecified
ILT37753Medicare UPIN