Physician Compare National (NPI:1104035633)

HEALTHCARE PROVIDER: RICHARD ELSON

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104035633
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193990604
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111212000945
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELSON
	Individual professional last name
Provider First Name	RICHARD
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WESTERN STATES COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	308 5TH AVE
	Group Practice or individual's line 1 address
City	FAIRBANKS
	Group Practice or individual's city
State	AK
	Group Practice or individual's state
Zip Code	997015026
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9074562244
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M