JERRY LEE ELLIOTT (NPI# 1639383052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639383052 |
| Entity Type | Individual |
| Full Name | JERRY LEE ELLIOTT |
| Credential | D.C. |
| Practice Address |
1300 Bancroft Ave Suite 104 San Leandro CA 94577-5147 |
| Practice Telephone | 5103579331 |
| Practice Fax Number | 5103516054 |
| Mailing Telephone | 5103579331 |
| Mailing Fax Number | 5103516054 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 15191 | CA | Chiropractic Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417020884 | Jerry L Elliott | Optometrist | 3159 S Garland Ave, 511b, Garland, TX 75041-4000 | 2006-11-15 |
| 1114152758 | Jerry G Elliott | Nurse Practitioner | 888 Swift Blvd, Richland, WA 99352 | 2009-05-27 |
| Street Address |
1300 BANCROFT AVE SUITE 104 |
| City | SAN LEANDRO |
| State | CA |
| Zip Code | 94577-5147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952350936 | Maria Elena Beamer | Pediatrics | 1300 Bancroft Ave, San Leandro, CA 94577-5147 | 2006-05-08 |
| 1376866707 | Zeineldin Ahmad | Podiatrist | 1300 Bancroft Ave, Suite#103, San Leandro, CA 94577-5147 | 2010-03-12 |
| 1508037078 | Darcy Elizabeth Grant | Pediatrics | 1300 Bancroft Ave, Suite 204, San Leandro, CA 94577-5147 | 2008-03-12 |
| 1558577866 | Rickey J. Wong | Dentist | 1300 Bancroft Ave, Ste. 101, San Leandro, CA 94577-5147 | 2007-05-15 |
| 1295940146 | Ronald Gene Crawford | Chiropractor | 1300 Bancroft Ave, Suite 104, San Leandro, CA 94577-5147 | 2007-05-14 |
| 1336352186 | John Wesley Daniels | Chiropractor | 1300 Bancroft Ave, Suite 104, San Leandro, CA 94577-5147 | 2007-05-08 |
| 1679633630 | Michael A. Stein Dpm | Podiatrist | 1300 Bancroft Ave, 103, San Leandro, CA 94577-5147 | 2006-12-11 |
| 1952489965 | John F. Polito | Obstetrics & Gynecology | 1300 Bancroft Ave, Suite G 4, San Leandro, CA 94577-5147 | 2006-11-01 |
| 1760568158 | Sassoon George Ezekiel | Specialist | 1300 Bancroft Ave, San Leandro, CA 94577-5147 | 2006-10-27 |
| 1922108448 | Eleanor Zeanette Haley | Dentist | 1300 Bancroft Ave, #202, San Leandro, CA 94577-5147 | 2006-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093358574 | A Caring Heart Home Health Inc. | In Home Supportive Care | 215-237 Estudillo Ave, Suite 202, San Leandro, CA 94577 | 2019-10-28 |
| 1871070052 | New Connections Neuropsychology, PC | Clinical Neuropsychologist | 1057 Macarthur Blvd, Ste 214, San Leandro, CA 94577 | 2018-07-20 |
| 1790287266 | Jennifer Capilla | Behavior Technician | 333 Estudillo Ave #204, San Leandro, CA 94577 | 2018-03-01 |
| 1891296760 | Maryann Kruse Bens | Clinical Neuropsychologist | 1057 Macarthur Blvd Ste 214, San Leandro, CA 94577 | 2018-02-26 |
| 1811406721 | Brendon Hoang Nguyen | Dentist | 145 E 14th St, San Leandro, CA 94577 | 2017-09-22 |
| 1801311774 | Calvin Walker | Counselor | 3801 Teagarden Street, San Leandro, CA 94577 | 2017-08-11 |
| 1184154999 | Shauntrinae Mason | Marriage & Family Therapist | 1000 San Leandro Blvd., Suite 300, San Leandro, CA 94577 | 2017-06-14 |
| 1912453135 | Dr. Marshea Evans | Point of Service | 1068 E14th Street, San Leandro, CA 94577 | 2016-08-28 |
| 1902252935 | Mobility Express Medical Transportation | Non-emergency Medical Transport (VAN) | 1695 Abram Ct Ste 202, San Leandro, CA 94577 | 2016-05-09 |
| 1194170381 | Girls Incorporated of Alameda County | Community/Behavioral Health | 2251 Bancroft Ave, San Leandro, CA 94577 | 2016-04-26 |
| Find all providers in zip 94577 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902278872 | Don J. Grundmann | Chiropractor | 425 E. Merle Ct., San Leandro, CA 94577 | 2015-10-30 |
| 1659637999 | David Irvin Dufour | Chiropractor | 585 Dowling Blvd, San Leandro, CA 94577-1905 | 2012-04-10 |
| 1407185515 | Sandi Diane Jones | Chiropractor | 875 Estudillo Ave, San Leandro, CA 94577-5111 | 2009-12-18 |
| 1326241399 | Michael H. Mortensen | Chiropractor | 505 Bancroft Ave, San Leandro, CA 94577-2023 | 2007-06-07 |
| 1487866018 | Christopher Daniel Macchesney | Chiropractor | 144 Joaquin Ave, San Leandro, CA 94577-4708 | 2007-05-04 |
| 1043438039 | Monisha Mona Chanan | Chiropractor | 15200 Hesperian Blvd, Suite 104, San Leandro, CA 94578 | 2007-04-23 |
| 1881718302 | Steve Camenson | Chiropractor | 14399 E 14th St, San Leandro, CA 94578-2711 | 2007-03-19 |
| 1225166036 | Burt Chiropractic Professional Corporation | Chiropractor | 15200 Hesperian Blvd Ste 104, San Leandro, CA 94578-3955 | 2007-03-01 |
| 1194864421 | Advanced Multi Specialty Medical Group | Chiropractor | 1460-1470 150th Ave, San Leandro, CA 94578-1821 | 2007-02-05 |
| 1659444081 | Nghia John Phan | Chiropractor | 433 Estudillo Ave Ste 100, San Leandro, CA 94577-4915 | 2006-11-15 |
| Find all providers in SAN LEANDRO | ||||
| City | SAN LEANDRO |
| Zip Code | 94577 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.