Provider Demographics
NPI:1023704384
Name:ELLIOTT, DENNIS JR (DACM, LAC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:ELLIOTT
Suffix:JR
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93695
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90093-0695
Mailing Address - Country:US
Mailing Address - Phone:330-268-5919
Mailing Address - Fax:
Practice Address - Street 1:16430 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2141
Practice Address - Country:US
Practice Address - Phone:818-478-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist