Provider Demographics
NPI:1861447476
Name:THOMAS, ELLEN R (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WOODSIDE LN
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2462
Mailing Address - Country:US
Mailing Address - Phone:843-368-4252
Mailing Address - Fax:856-608-8851
Practice Address - Street 1:1221 N CHURCH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1245
Practice Address - Country:US
Practice Address - Phone:843-368-4252
Practice Address - Fax:856-608-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00249200111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician