MEDICARE: DEMETRIS WILLIAM ELIA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	14178	TX

General Provider Information

NPI Number	:	1386267052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIS WILLIAM ELIA DC

Provider Business Mailing Address
First Line	:	7712 ROYAL LN APT C
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3704
Country	:	US
Telephone Number	:	915-356-9102
Fax Number	:

Provider Business Practice Location Address
First Line	:	7712 ROYAL LN APT C
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3704
Country	:	US
Telephone Number	:	915-356-9102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	05/28/2020

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Directions to “ DEMETRIS WILLIAM ELIA DC” Practice Location

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