Provider Demographics
NPI:1609365865
Name:ELLEN WEIS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ELLEN WEIS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-239-5025
Mailing Address - Street 1:15368 FROST PATH
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6067
Mailing Address - Country:US
Mailing Address - Phone:612-930-3646
Mailing Address - Fax:
Practice Address - Street 1:15368 FROST PATH
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6067
Practice Address - Country:US
Practice Address - Phone:612-930-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty