Provider Demographics
NPI:1346318458
Name:SCHULTZ ELLIS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SCHULTZ ELLIS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:910-862-8544
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-2485
Mailing Address - Country:US
Mailing Address - Phone:910-862-8544
Mailing Address - Fax:910-862-3569
Practice Address - Street 1:196 N PINE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9245
Practice Address - Country:US
Practice Address - Phone:910-862-8544
Practice Address - Fax:910-862-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790842AMedicaid
NC7908771Medicaid
NC790842AMedicaid
NC1368Medicare PIN
NC2453912AMedicare ID - Type Unspecified
NCT64575Medicare UPIN
NC244572BMedicare ID - Type Unspecified