Healthcare Provider Details

I. General information

NPI: 1891387650
Provider Name (Legal Business Name): ELAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#604 AVE TOSE EFRON PASEO DEL PATA SHOPPING VILLAGE SUITE #6106 BLDG #4
DORADO PR
00646
US

IV. Provider business mailing address

#604 AVE TOSE EFRON PASEO DEL PATA SHOPPING VILLAGE SUITE #6106 BLDG #4
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-8754
  • Fax:
Mailing address:
  • Phone: 787-998-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE BERRIOS
Title or Position: ADMINISTRATOR/CHIROPRACTOR
Credential: DC
Phone: 787-998-8754