Healthcare Provider Details

I. General information

NPI: 1609097559
Provider Name (Legal Business Name): JAMES J ELROD L.M.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E. MAIN ST.
CANFIELD OH
44406
US

IV. Provider business mailing address

P.O. BOX 1302
SALEM OH
44460
US

V. Phone/Fax

Practice location:
  • Phone: 330-360-7066
  • Fax: 330-533-8966
Mailing address:
  • Phone: 330-360-7066
  • Fax: 330-533-8966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: