Provider Demographics
NPI:1376790220
Name:ELLISON, KRISTY (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:ELLISON
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 1:3683 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:614-801-1307
Mailing Address - Fax:614-227-3503
Practice Address - Street 1:1101 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8711
Practice Address - Country:US
Practice Address - Phone:304-757-4515
Practice Address - Fax:304-757-4517
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor