Provider Demographics
NPI:1962607705
Name:ELLER CHIROPRACTIC
Entity type:Organization
Organization Name:ELLER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOSS
Authorized Official - Prefix:DR
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-895-1151
Mailing Address - Street 1:1810 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2312
Mailing Address - Country:US
Mailing Address - Phone:530-895-1151
Mailing Address - Fax:530-895-1147
Practice Address - Street 1:1810 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2312
Practice Address - Country:US
Practice Address - Phone:530-895-1151
Practice Address - Fax:530-895-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32152ZMedicare ID - Type UnspecifiedCORP PIN#