Provider Demographics
NPI:1225027584
Name:ELLERAAS, CHRISTOPHER RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:ELLERAAS
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 1:3830 VALLEY CENTRE DR.
Mailing Address - Street 2:#704
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2331
Mailing Address - Country:US
Mailing Address - Phone:858-792-9000
Mailing Address - Fax:858-792-9001
Practice Address - Street 1:3830 VALLEY CENTRE DR.
Practice Address - Street 2:#704
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-792-9000
Practice Address - Fax:858-792-9001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU66536Medicare UPIN