Provider Demographics
NPI:1700516325
Name:ELIAS, CHRIS SIMON (NMT,CPT,SNS)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:SIMON
Last Name:ELIAS
Suffix:
Gender:M
Credentials:NMT,CPT,SNS
Other - Prefix:
Other - First Name:THE
Other - Middle Name:MUSCLE
Other - Last Name:WHISPERER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8458 N STAR WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-3843
Mailing Address - Country:US
Mailing Address - Phone:916-605-9691
Mailing Address - Fax:
Practice Address - Street 1:1380 LEAD HILL BLVD STE 211
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2997
Practice Address - Country:US
Practice Address - Phone:916-359-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
CA2255A2300X
CA87156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87156OtherCAMTC