Provider Demographics
NPI:1962444695
Name:ELSNER, GERALD G (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:G
Last Name:ELSNER
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 1:3105 NE 11TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9102
Mailing Address - Country:US
Mailing Address - Phone:479-254-1177
Mailing Address - Fax:479-254-1193
Practice Address - Street 1:3105 NE 11TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-9102
Practice Address - Country:US
Practice Address - Phone:479-254-1177
Practice Address - Fax:479-254-1193
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X248OtherBCBS PROVIDER ID#
AR5X248OtherBCBS PROVIDER ID#