Provider Demographics
NPI:1851499297
Name:ELLINGSON FAMILY CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:ELLINGSON FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-541-9311
Mailing Address - Street 1:5410 NC HIGHWAY 55
Mailing Address - Street 2:SUITE E
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7800
Mailing Address - Country:US
Mailing Address - Phone:919-541-9311
Mailing Address - Fax:
Practice Address - Street 1:5410 NC HIGHWAY 55
Practice Address - Street 2:SUITE E
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7800
Practice Address - Country:US
Practice Address - Phone:919-541-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC651206OtherACN
NC085GMOtherBLUECROSS BLUESHIELD
NC89085GMMedicaid
NCU92388Medicare UPIN
NC2454540Medicare PIN