Individual
ELTON E BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BOC/ABC
Contact information
Practice address
1 JARRETT WHITE RD DEPT OF THE ARMY, ATTN: ORTHOPEDIC BRACE CLINIC (MCHK-DSO-A), TRIPLER AMC, HI 96859
(808) 433-6967
(808) 433-9227
Mailing address
1 JARRETT WHITE RD DEPT OF THE ARMY, ATTN: ORTHOPEDIC BRACE CLINIC (MCHK-DSO-A), TRIPLER AMC, HI 96859
(808) 433-6967
(808) 433-9227
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C13175
BOC
HI
01
—
CO004280
ABC
HI
Enumeration date
03/01/2012
Last updated
03/01/2012
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