1326187279 NPI number — DR. ALICE BAIN ELROD D.C.

Table of content: DR. ALICE BAIN ELROD D.C. (NPI 1326187279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326187279 NPI number — DR. ALICE BAIN ELROD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELROD
Provider First Name:
ALICE
Provider Middle Name:
BAIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1326187279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1924
Provider Second Line Business Mailing Address:
ELROD CHIROPRACTIC
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59917-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-297-3422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 DEWEY AVE.
Provider Second Line Business Practice Location Address:
ELROD CHIROPRACTIC
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-297-3422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007

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: 111N00000X , with the licence number:  1003 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90-0005387 . This is a "TAX ID" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000163982 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000163995 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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