Provider Demographics
NPI:1487635058
Name:ELLIOTT, STEVEN RAY (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3906 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5754
Mailing Address - Country:US
Mailing Address - Phone:936-639-1014
Mailing Address - Fax:936-639-1099
Practice Address - Street 1:3906 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5754
Practice Address - Country:US
Practice Address - Phone:936-639-1014
Practice Address - Fax:936-639-1099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2481111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600809Medicare ID - Type Unspecified