Provider Demographics
NPI:1588065106
Name:ELCOCK, CORAL (DC)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:ELCOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1006
Mailing Address - Country:US
Mailing Address - Phone:917-497-8129
Mailing Address - Fax:
Practice Address - Street 1:264 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1006
Practice Address - Country:US
Practice Address - Phone:917-497-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX06643DUP111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor