Provider Demographics
NPI:1821316951
Name:ELLIS, GABRIEL GRIFFITH (DC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:GRIFFITH
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 1:101 HEMPSTEAD PL
Mailing Address - Street 2:COMMUNITY CHIROPRACTIC CENTER
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-1745
Mailing Address - Country:US
Mailing Address - Phone:815-774-9985
Mailing Address - Fax:815-774-0235
Practice Address - Street 1:127 CAPISTA DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8551
Practice Address - Country:US
Practice Address - Phone:815-609-6150
Practice Address - Fax:815-774-0235
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor