Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH 11883 | FL |
NPI | 1003269101 |
---|---|
Provider Name | Dr. Elliot Jay Hassen |
First Address | Ormond Beach, FL 32174-7332 |
Second Address | Ormond Beach, FL 32174-7332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 29/03/2017 |