Provider Demographics
NPI:1568519296
Name:ELLINGSON, PATRICIA LYNN (D C)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 JEFFERSON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1705
Mailing Address - Country:US
Mailing Address - Phone:760-696-1571
Mailing Address - Fax:
Practice Address - Street 1:2725 JEFFERSON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1705
Practice Address - Country:US
Practice Address - Phone:760-696-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26920Medicare PIN
CAU80170Medicare UPIN