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NPI Code Detail

MEDICARE: DR. BERNICE LORRAINE ELLIOTT DC

MEDICARE:  DR. BERNICE LORRAINE ELLIOTT  DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3166-012WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447268586
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNICE LORRAINE ELLIOTT DC
Provider Business Mailing Address
First Line : 730 ANN ST
Second Line :
City : LAKE GENEVA
State : WI
Zip : 53147-1418
Country : US
Telephone Number : 262-348-9294
Fax Number :
Provider Business Practice Location Address
First Line : 541 KENOSHA ST
Second Line :
City : WALWORTH
State : WI
Zip : 53184-9538
Country : US
Telephone Number : 262-275-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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Directions to “ DR. BERNICE LORRAINE ELLIOTT DC” Practice Location

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