Provider Demographics
NPI:1003014168
Name:ELLIOTT, JOHN M (CSFA/DO/PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:CSFA/DO/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MID DALE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2615
Mailing Address - Country:US
Mailing Address - Phone:502-599-5778
Mailing Address - Fax:
Practice Address - Street 1:2150 S CENTRAL EXPY STE 130
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4068
Practice Address - Country:US
Practice Address - Phone:972-363-8200
Practice Address - Fax:972-363-8195
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107788246ZC0007X
KYSA170246ZC0007X
ZZFFF/11/296175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No175L00000XOther Service ProvidersHomeopath