Provider Demographics
NPI:1558370932
Name:ELLIS, ANTHONY NASSIF (DC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:NASSIF
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 1:13206 COTTNER STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137
Mailing Address - Country:US
Mailing Address - Phone:402-896-2496
Mailing Address - Fax:402-896-2497
Practice Address - Street 1:13206 COTTNER STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-896-2496
Practice Address - Fax:402-896-2497
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025175300Medicaid
U76356Medicare UPIN
NE099585Medicare ID - Type Unspecified