Provider Demographics
NPI:1871673947
Name:LEVY, ELLIOT (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:LEVY
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-0454
Mailing Address - Country:US
Mailing Address - Phone:315-245-3020
Mailing Address - Fax:315-245-3021
Practice Address - Street 1:96 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1320
Practice Address - Country:US
Practice Address - Phone:315-245-3020
Practice Address - Fax:315-245-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO11141-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10905087OtherCAQH
NYIA0868Medicare ID - Type Unspecified
NY65097Medicare UPIN