Provider Demographics
NPI:1245295930
Name:ELWART, FRANCIS VINCENT (DC)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:VINCENT
Last Name:ELWART
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 1:5761 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4493
Mailing Address - Country:US
Mailing Address - Phone:248-626-6892
Mailing Address - Fax:248-855-2477
Practice Address - Street 1:25900 GREENFIELD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1292
Practice Address - Country:US
Practice Address - Phone:248-352-5851
Practice Address - Fax:248-352-5812
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4844286Medicaid
MI950D410490OtherBC/BS OF MICHIGAN PROVIDE
MI4844286Medicaid
MI421713515OtherTAX ID NUMBER
MIU99699Medicare UPIN
MIP16430002Medicare ID - Type Unspecified
MI352200609OtherTAX ID NUMBER