Provider Demographics
NPI:1184621708
Name:ELIJAH, BRIAN S (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:ELIJAH
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 1:8900 PENN AVE S
Mailing Address - Street 2:SUITE #116
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2068
Mailing Address - Country:US
Mailing Address - Phone:952-884-3700
Mailing Address - Fax:612-656-0555
Practice Address - Street 1:8900 PENN AVE S
Practice Address - Street 2:SUITE #116
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2068
Practice Address - Country:US
Practice Address - Phone:952-884-3700
Practice Address - Fax:612-656-0550
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1B00B6CHOtherBCBS CLINIC ID
MN4485431OtherMEDICA PROVIDER ID
MN00B97ELOtherBCBS PROVIDER ID