Provider Demographics
NPI:1417491275
Name:ELLIS, KRISTEN (DC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name: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 1:7487 N CLIO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-8227
Mailing Address - Country:US
Mailing Address - Phone:810-687-6100
Mailing Address - Fax:810-687-5541
Practice Address - Street 1:7487 N CLIO RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-8227
Practice Address - Country:US
Practice Address - Phone:810-687-6100
Practice Address - Fax:810-687-5541
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor