Provider Demographics
NPI:1861843492
Name:ELDER, MARY JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:ELDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 FARM RD 2222
Mailing Address - Street 2:BUILDING 3C SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1159
Mailing Address - Country:US
Mailing Address - Phone:512-345-9355
Mailing Address - Fax:
Practice Address - Street 1:10815 FARM RD 2222
Practice Address - Street 2:BUILDING 3C SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1159
Practice Address - Country:US
Practice Address - Phone:512-345-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor