Healthcare Provider Details

I. General information

NPI: 1922180124
Provider Name (Legal Business Name): JUSTIN KEITH ELDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4926 42ND AVE N
ROBBINSDALE MN
55422-1731
US

IV. Provider business mailing address

4926 42ND AVE N
ROBBINSDALE MN
55422-1731
US

V. Phone/Fax

Practice location:
  • Phone: 763-537-3927
  • Fax: 763-537-1421
Mailing address:
  • Phone: 763-537-3927
  • Fax: 763-537-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4338
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: