Provider Demographics
NPI:1679799902
Name:ELMORE, NATHAN WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WESLEY
Last Name:ELMORE
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 1:1842 SOUTH 2000 WEST
Mailing Address - Street 2:# 2
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-774-7540
Mailing Address - Fax:801-774-7542
Practice Address - Street 1:1842 SOUTH 2000 WEST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075
Practice Address - Country:US
Practice Address - Phone:801-774-7540
Practice Address - Fax:801-774-7542
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5042020-1202111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition