1962444695 NPI number — DR. GERALD G ELSNER D.C

Table of content: DR. GERALD G ELSNER D.C (NPI 1962444695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962444695 NPI number — DR. GERALD G ELSNER D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELSNER
Provider First Name:
GERALD
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
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:
1962444695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 NE 11TH ST
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-9102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-254-1177
Provider Business Mailing Address Fax Number:
479-254-1193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 NE 11TH ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-9102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-254-1177
Provider Business Practice Location Address Fax Number:
479-254-1193
Provider Enumeration Date:
06/10/2006

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:  7588 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5X248 . This is a "BCBS PROVIDER ID#" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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