Provider Demographics
NPI:1891823647
Name:ELLIOTT, STEVAN HUGH (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVAN
Middle Name:HUGH
Last Name:ELLIOTT
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 1:1828 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2735
Mailing Address - Country:US
Mailing Address - Phone:410-882-7670
Mailing Address - Fax:410-882-1623
Practice Address - Street 1:1828 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2735
Practice Address - Country:US
Practice Address - Phone:410-882-7670
Practice Address - Fax:410-882-1623
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401594-01Medicare UPIN
MDM226-SHMedicare ID - Type Unspecified