Provider Demographics
NPI:1952462848
Name:ELLIOTT CHIROPRACTIC OFFICE PC
Entity Type:Organization
Organization Name:ELLIOTT CHIROPRACTIC OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-433-4112
Mailing Address - Street 1:121 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-5003
Mailing Address - Country:US
Mailing Address - Phone:815-433-4112
Mailing Address - Fax:
Practice Address - Street 1:121 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-5003
Practice Address - Country:US
Practice Address - Phone:815-433-4112
Practice Address - Fax:815-433-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350128080OtherMEDICARE RAILROAD
IL005082005OtherBLUE CROSS BLUE SHIELD
IL1518928050OtherNPI INDIVIDUAL
IL259850Medicare ID - Type Unspecified
IL350128080OtherMEDICARE RAILROAD