Provider Demographics
NPI:1508910753
Name:ELLINGTON, GEOFFREY C (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:C
Last Name:ELLINGTON
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 1:390 N BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1253
Mailing Address - Country:US
Mailing Address - Phone:856-678-5975
Mailing Address - Fax:
Practice Address - Street 1:390 N BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1253
Practice Address - Country:US
Practice Address - Phone:856-678-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00361200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
30815OtherAETNA
NJ577518Medicare ID - Type Unspecified