=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457565574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY ELLIOTT DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 10/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2104 OAKTON ST
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-1820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-692-6956
-----------------------------------------------------
Fax | 847-692-9651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2104 OAKTON ST
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-1820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-692-6956
-----------------------------------------------------
Fax | 847-692-9651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NANCY ELLIOTT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 847-692-6956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038004676
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------