Provider Demographics
NPI:1942594239
Name:ELLIOTT CHIROPRACTIC CENTER L.L.C.
Entity Type:Organization
Organization Name:ELLIOTT CHIROPRACTIC CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-597-2273
Mailing Address - Street 1:3585 VAN TEYLINGEN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4875
Mailing Address - Country:US
Mailing Address - Phone:719-597-2273
Mailing Address - Fax:719-597-2427
Practice Address - Street 1:3585 VAN TEYLINGEN DR
Practice Address - Street 2:SUITE D
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4875
Practice Address - Country:US
Practice Address - Phone:719-597-2273
Practice Address - Fax:719-597-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1C443178Medicare PIN
CO1C443178Medicare UPIN