Provider Demographics
NPI:1104974344
Name:ELSHOLZ, JESSE (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:ELSHOLZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2837
Mailing Address - Country:US
Mailing Address - Phone:908-334-0350
Mailing Address - Fax:
Practice Address - Street 1:72 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2211
Practice Address - Country:US
Practice Address - Phone:516-922-4606
Practice Address - Fax:516-922-4399
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor