Healthcare Provider Details

I. General information

NPI: 1063588333
Provider Name (Legal Business Name): TODD JAMES ELERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 2ND AVE E
LUCK WI
54853-0266
US

IV. Provider business mailing address

PO BOX 266
LUCK WI
54853-0266
US

V. Phone/Fax

Practice location:
  • Phone: 715-472-2626
  • Fax:
Mailing address:
  • Phone: 715-472-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2523
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2816
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: