Provider Demographics
NPI:1417045279
Name:HOFFMAN, ELLEN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARIE
Last Name:HOFFMAN
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 1:884 PORTOLA ROAD
Mailing Address - Street 2:A5
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028
Mailing Address - Country:US
Mailing Address - Phone:650-851-4860
Mailing Address - Fax:650-851-4974
Practice Address - Street 1:884 PORTOLA ROAD
Practice Address - Street 2:A5
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028
Practice Address - Country:US
Practice Address - Phone:650-851-4860
Practice Address - Fax:650-851-4974
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADCO17876Medicare ID - Type UnspecifiedMEDICARE