Provider Demographics
NPI:1932296951
Name:ELLIOTT CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:ELLIOTT CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:828-438-1152
Mailing Address - Street 1:300 N TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3753
Mailing Address - Country:US
Mailing Address - Phone:828-438-1152
Mailing Address - Fax:828-438-1162
Practice Address - Street 1:300 N TERRACE PL
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3753
Practice Address - Country:US
Practice Address - Phone:828-438-1152
Practice Address - Fax:828-438-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901680Medicaid
NC5901680Medicaid
NCA901Medicare PIN