Phillip Otto Elliott, DC
Individual provider Active NPI Chiropractor · Martin, TN
NPI 1992877435 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992877435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 650 (TN)
- Practice address
- 415 N Lindell St
Martin, TN 38237 - Phone
- (731) 587-4844
- Fax
- (731) 587-6583
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Life Chiropractic College - West, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
415 N Lindell St
Martin, TN 38237-1819
Phone (731) 587-4844
602 Phillips Dr
Wickliffe, KY 42087-9361
Phone (270) 335-5116
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY, TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040901001162 | KY | Practitioner - Chiropractic | 3375518277 | Practice locations: Wickliffe, KY |
| I20160705000593 | TN | Practitioner - Chiropractic | 3375518277 | Practice locations: Martin, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4013 | KY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 650 | TN | Yes |
Addresses
Primary practice location
415 N Lindell St
Martin, TN 38237
Mailing address
415 N Lindell St
Martin, TN 38237
Phone (731) 587-4844
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6069101 | Medicaid | KY | |
| 117021 | Other | TN | BETTER HEALTH |
| 3121613 | Other | TN | BC BN OF TN |
Other providers in Martin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.