Provider Demographics
NPI:1093020083
Name:ELLIS, LISA O'NEILL (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:O'NEILL
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S GREENVILLE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4103
Mailing Address - Country:US
Mailing Address - Phone:214-924-0371
Mailing Address - Fax:
Practice Address - Street 1:210 S GREENVILLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4103
Practice Address - Country:US
Practice Address - Phone:214-924-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11539111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor