Provider Demographics
NPI:1760024061
Name:ELLIOTT SPINE & SPORT, PLLC
Entity Type:Organization
Organization Name:ELLIOTT SPINE & SPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LAT, DC
Authorized Official - Phone:713-471-4412
Mailing Address - Street 1:13812 CORTES DE PALLAS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1065
Mailing Address - Country:US
Mailing Address - Phone:713-471-4412
Mailing Address - Fax:
Practice Address - Street 1:2103 E ELDORADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5868
Practice Address - Country:US
Practice Address - Phone:469-200-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty