Healthcare Provider Details

I. General information

NPI: 1285608620
Provider Name (Legal Business Name): RICHARD A ELBERT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BURNETT AVE
AMES IA
50010-6126
US

IV. Provider business mailing address

622 BURNETT AVE
AMES IA
50010-6126
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-9075
  • Fax: 515-232-4995
Mailing address:
  • Phone: 515-232-9075
  • Fax: 515-232-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4631
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1295
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3862-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: