Provider Demographics
NPI:1871655027
Name:ELLIS CHIROPRACTIC AND REHABILITATION INC.
Entity Type:Organization
Organization Name:ELLIS CHIROPRACTIC AND REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-955-2225
Mailing Address - Street 1:12015 PERRY RD
Mailing Address - Street 2:A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5153
Mailing Address - Country:US
Mailing Address - Phone:281-955-2225
Mailing Address - Fax:281-955-2230
Practice Address - Street 1:12015 PERRY RD
Practice Address - Street 2:A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5153
Practice Address - Country:US
Practice Address - Phone:281-955-2225
Practice Address - Fax:281-955-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty