Provider Demographics
NPI:1518188408
Name:ELLIS, RACHEL MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:NASCENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3060A WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9617
Mailing Address - Country:US
Mailing Address - Phone:651-731-5124
Mailing Address - Fax:651-731-0509
Practice Address - Street 1:3060A WOODBURY DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9617
Practice Address - Country:US
Practice Address - Phone:651-731-5124
Practice Address - Fax:651-731-0509
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor