Provider Demographics
NPI:1720246028
Name:VOTAVA, ELSA BYATT (DC)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:BYATT
Last Name:VOTAVA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5111
Mailing Address - Country:US
Mailing Address - Phone:518-537-6110
Mailing Address - Fax:518-537-6110
Practice Address - Street 1:1604 ROUTE 9
Practice Address - Street 2:
Practice Address - City:TIVOLI
Practice Address - State:NY
Practice Address - Zip Code:12583-5111
Practice Address - Country:US
Practice Address - Phone:518-537-6110
Practice Address - Fax:518-537-6110
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005030-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
33191Medicare UPIN