Provider Demographics
NPI:1740466952
Name:ELDER CHIROPRACTIC BACK & NECK PAIN, INC.
Entity type:Organization
Organization Name:ELDER CHIROPRACTIC BACK & NECK PAIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-428-4466
Mailing Address - Street 1:5417 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2105
Mailing Address - Country:US
Mailing Address - Phone:916-428-4466
Mailing Address - Fax:916-428-5322
Practice Address - Street 1:5417 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2105
Practice Address - Country:US
Practice Address - Phone:916-428-4466
Practice Address - Fax:916-428-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty