MEDICARE: DR. RUSSELL TODD ELBA D.C.

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	CH0006180	FL

General Provider Information

NPI Number	:	1598817827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL TODD ELBA D.C.

Provider Business Mailing Address
First Line	:	5810 STIRLING RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1527
Country	:	US
Telephone Number	:	954-961-2245
Fax Number	:	954-961-3344

Provider Business Practice Location Address
First Line	:	5810 STIRLING RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1527
Country	:	US
Telephone Number	:	954-961-2245
Fax Number	:	954-961-3344

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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