Healthcare Provider Details

I. General information

NPI: 1720246028
Provider Name (Legal Business Name): ELSA BYATT VOTAVA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 ROUTE 9
TIVOLI NY
12583-5111
US

IV. Provider business mailing address

1604 ROUTE 9
TIVOLI NY
12583-5111
US

V. Phone/Fax

Practice location:
  • Phone: 518-537-6110
  • Fax: 518-537-6110
Mailing address:
  • Phone: 518-537-6110
  • Fax: 518-537-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005030-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: