Provider Demographics
NPI:1710127394
Name:ELLIOT, JEFFREY KYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KYLE
Last Name:ELLIOT
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 1:936 WATERFORD DR E
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1932
Mailing Address - Country:US
Mailing Address - Phone:651-230-5355
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:SUITE 515
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:952-210-9310
Practice Address - Fax:952-926-8155
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5164111N00000X
WI4474-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11989599OtherCAQH