Individual
DANIEL JACOB ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2515
(231) 591-3780
Mailing address
1405 GROSBECK RD, LAPEER, MI 48446-3418
(810) 441-1640
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/17/2018
Last updated
01/17/2018
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