Healthcare Provider Details

I. General information

NPI: 1528233699
Provider Name (Legal Business Name): HANY M ELEWA DC PHD NCEA DIP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N10548 CTY G
NEW HOLSTEIN WI
53061
US

IV. Provider business mailing address

N10548 CTY G
NEW HOLSTEIN WI
53061
US

V. Phone/Fax

Practice location:
  • Phone: 920-898-9735
  • Fax: 920-898-4258
Mailing address:
  • Phone: 920-898-9735
  • Fax: 920-898-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2966012
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number266055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: