Provider Demographics
NPI:1962596528
Name:ELMENHURST, DALE ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ANTHONY
Last Name:ELMENHURST
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 1:903 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3326
Mailing Address - Country:US
Mailing Address - Phone:509-525-4160
Mailing Address - Fax:509-522-9921
Practice Address - Street 1:903 S HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3326
Practice Address - Country:US
Practice Address - Phone:509-525-4160
Practice Address - Fax:509-522-9921
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000 02843111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001300092Medicare ID - Type Unspecified
WAU41935Medicare UPIN