Provider Demographics
NPI:1285608620
Name:ELBERT, RICHARD A (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:ELBERT
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 1:622 BURNETT AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6126
Mailing Address - Country:US
Mailing Address - Phone:515-232-9075
Mailing Address - Fax:515-232-4995
Practice Address - Street 1:622 BURNETT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6126
Practice Address - Country:US
Practice Address - Phone:515-232-9075
Practice Address - Fax:515-232-4995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4631111N00000X
CO1295111N00000X
WI3862-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15559OtherBCBS PROVIDER NUMBER
IA0155598Medicaid
IA15559Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER