1992474860 NPI number — JAMES E ELLIOTT V DPT

Table of content: JAMES E ELLIOTT V DPT (NPI 1992474860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992474860 NPI number — JAMES E ELLIOTT V DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
V
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992474860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59903-5718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-756-0134
Provider Business Mailing Address Fax Number:
406-300-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80304-3573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-440-3034
Provider Business Practice Location Address Fax Number:
303-402-1665
Provider Enumeration Date:
09/13/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTL.0017870 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)