Basic Information
| Provider Information | |||||||||
| NPI: | 1003014168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | C.S.F.A./D.O./PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 MID DALE LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402202615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025995778 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2150 S CENTRAL EXPY STE 130 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750704068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723638200 | ||||||||
| FaxNumber: | 9723638195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 107788 | CO | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 246ZC0007X | SA170 | KY | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 175L00000X | FFF/11/296 | ZZ | N | Other Service Providers | Homeopath |
No ID Information.