Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR010098 | GA |
Y | 111NS0005X | Chiropractic Sports Physician | CHIR010098 | GA |
NPI | 1154804474 |
---|---|
Provider Name | Dr. Halie Elchos |
First Address | Kennesaw, GA 30160-9508 |
Second Address | Kennesaw, GA 30144-6908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2018 |
Last Update Date | 12/09/2018 |