Provider Demographics
NPI:1821192121
Name:CARDWELL, ELBERT HUGH (DC)
Entity Type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:HUGH
Last Name:CARDWELL
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 1:1230 JOHNSON FERRY ROAD
Mailing Address - Street 2:SUITE G 30
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2058
Mailing Address - Country:US
Mailing Address - Phone:770-977-9200
Mailing Address - Fax:770-977-5531
Practice Address - Street 1:1230 JOHNSON FERRY ROAD
Practice Address - Street 2:SUITE G 30
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2058
Practice Address - Country:US
Practice Address - Phone:770-977-9200
Practice Address - Fax:770-977-5531
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor