Provider Demographics
NPI:1083798557
Name:ELLIS, JOHN FRANKLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANKLIN
Last Name:ELLIS
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 1:2368 US HIGHWAY 23 N
Mailing Address - Street 2:STE 102
Mailing Address - City:WEBER CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24290-7384
Mailing Address - Country:US
Mailing Address - Phone:276-386-6666
Mailing Address - Fax:276-386-6666
Practice Address - Street 1:2368 US HIGHWAY 23 N
Practice Address - Street 2:STE 102
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290-7384
Practice Address - Country:US
Practice Address - Phone:276-386-6666
Practice Address - Fax:276-386-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA702111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21669Medicare UPIN