Provider Demographics
NPI:1639258544
Name:ELREY, SAMUEL T (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:ELREY
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 1:7350 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6427
Mailing Address - Country:US
Mailing Address - Phone:520-296-3999
Mailing Address - Fax:520-296-4999
Practice Address - Street 1:7350 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6427
Practice Address - Country:US
Practice Address - Phone:520-296-3999
Practice Address - Fax:520-296-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU13026Medicare UPIN
AZZDC4607Medicare PIN