Provider Demographics
NPI:1053439265
Name:CANTER, ELLIOT BENSON (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:BENSON
Last Name:CANTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 N COAST HIGHWAY 101 STE F7
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2542
Mailing Address - Country:US
Mailing Address - Phone:760-942-4702
Mailing Address - Fax:
Practice Address - Street 1:374 N COAST HIGHWAY 101 STE F7
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2542
Practice Address - Country:US
Practice Address - Phone:760-942-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69373Medicare UPIN