Provider Demographics
NPI:1720049851
Name:ELLIOTT, ANDREW WALLACE (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WALLACE
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2727
Mailing Address - Country:US
Mailing Address - Phone:541-345-5092
Mailing Address - Fax:
Practice Address - Street 1:260 E 15TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4177
Practice Address - Country:US
Practice Address - Phone:541-343-0571
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR450175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR157946Medicare UPIN