Provider Demographics
NPI:1104565092
Name:DAVID AUSTIN CALE ELKIN LLC
Entity type:Organization
Organization Name:DAVID AUSTIN CALE ELKIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO/PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:AUSTIN CALE
Authorized Official - Last Name:ELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-710-6653
Mailing Address - Street 1:11621 S CLEVELAND AVE STE 80
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2866
Mailing Address - Country:US
Mailing Address - Phone:519-717-4510
Mailing Address - Fax:
Practice Address - Street 1:11621 S CLEVELAND AVE STE 80
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2866
Practice Address - Country:US
Practice Address - Phone:519-717-4510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty