Provider Demographics
NPI:1649365453
Name:ELLIOTT, SAMUEL (DC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ELLIOTT
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 1:300 N TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3753
Mailing Address - Country:US
Mailing Address - Phone:828-438-1153
Mailing Address - Fax:828-438-1162
Practice Address - Street 1:300 N TERRACE PL
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3753
Practice Address - Country:US
Practice Address - Phone:828-438-1153
Practice Address - Fax:828-438-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890849KMedicaid
NC0849KOtherBCBS
NC0849KOtherCNC
NC0849KOtherCNC
NCU90730Medicare UPIN
NCNC5345A901Medicare PIN