Provider Demographics
NPI:1437618055
Name:ELLIS, JASON DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 BALTIMORE ST STE D
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8248
Mailing Address - Country:US
Mailing Address - Phone:717-797-2760
Mailing Address - Fax:
Practice Address - Street 1:1446 BALTIMORE ST STE D
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8248
Practice Address - Country:US
Practice Address - Phone:717-797-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011155111N00000X
MDS03885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty