Provider Demographics
NPI:1538197736
Name:GLOBKE, ELIAH (DC)
Entity type:Individual
Prefix:DR
First Name:ELIAH
Middle Name:
Last Name:GLOBKE
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 1:240 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-6709
Mailing Address - Country:US
Mailing Address - Phone:318-283-5007
Mailing Address - Fax:318-283-5008
Practice Address - Street 1:240 HOLT ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4054
Practice Address - Country:US
Practice Address - Phone:318-283-5007
Practice Address - Fax:318-283-5008
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B495CV67Medicare PIN