Provider Demographics
NPI:1841402112
Name:ELLIOTT, EDWARD D (DIPLAC, LAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DIPLAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GRANDVIEW HTS
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8618
Mailing Address - Country:US
Mailing Address - Phone:828-406-1985
Mailing Address - Fax:
Practice Address - Street 1:181 GRANDVIEW HTS
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8618
Practice Address - Country:US
Practice Address - Phone:828-406-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC349171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist