Provider Demographics
NPI:1386267052
Name:ELIA, DEMETRIS WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:DEMETRIS
Middle Name:WILLIAM
Last Name:ELIA
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 1:7712 ROYAL LN APT C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3704
Mailing Address - Country:US
Mailing Address - Phone:915-356-9102
Mailing Address - Fax:
Practice Address - Street 1:7712 ROYAL LN APT C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3704
Practice Address - Country:US
Practice Address - Phone:915-356-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor