Provider Demographics
NPI:1548218415
Name:ELLIS, WENDELL L (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:L
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 1:1475 SIMPSON RD W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6685
Mailing Address - Country:US
Mailing Address - Phone:865-988-9088
Mailing Address - Fax:865-988-9299
Practice Address - Street 1:1475 SIMPSON RD W
Practice Address - Street 2:SUITE 1
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6685
Practice Address - Country:US
Practice Address - Phone:865-988-9088
Practice Address - Fax:865-988-9299
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN702004131OtherCARITEN
TN4078449OtherBLUE CROSS BLUE SHIELD
TN610495500OtherUSPS INJURY COMP.
TN9416305OtherCIGNA
TN4078449OtherBLUE CROSS BLUE SHIELD