Provider Demographics
NPI:1649767120
Name:WEIS, ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:WEIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2999 COUNTY ROAD 42 W STE 212
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5908
Mailing Address - Country:US
Mailing Address - Phone:952-882-1965
Mailing Address - Fax:
Practice Address - Street 1:2999 COUNTY ROAD 42 W STE 212
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5908
Practice Address - Country:US
Practice Address - Phone:952-882-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2019-04-08
Deactivation Date:2018-04-30
Deactivation Code:
Reactivation Date:2018-05-09
Provider Licenses
StateLicense IDTaxonomies
MN6498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor