Provider Demographics
NPI:1528109147
Name:ELCENKO-HECIMOVICH, MARGUERITE CHRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:CHRISTINE
Last Name:ELCENKO-HECIMOVICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARGUERITE
Other - Middle Name:CHRISTINE
Other - Last Name:ELCENKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2800 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4922
Mailing Address - Country:US
Mailing Address - Phone:925-754-6868
Mailing Address - Fax:925-754-5016
Practice Address - Street 1:2800 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4922
Practice Address - Country:US
Practice Address - Phone:925-754-6868
Practice Address - Fax:925-754-5016
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24983ZMedicare ID - Type UnspecifiedGROUP NUMBER