Provider Demographics
NPI:1275666760
Name:ASCHER ELLIS, RENEE (DC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ASCHER 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 1:5002 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3439
Mailing Address - Country:US
Mailing Address - Phone:920-803-0270
Mailing Address - Fax:
Practice Address - Street 1:3144 WILGUS AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3045
Practice Address - Country:US
Practice Address - Phone:920-451-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4105-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38962300Medicaid
WI38962300Medicaid