Provider Demographics
NPI:1891972527
Name:ELLIS CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:ELLIS CHIROPRACTIC CLINIC, LLC
Other - Org Name:ELLIS HEALTH CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-739-4010
Mailing Address - Street 1:3391 COUNTY ROAD 2240
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-8546
Mailing Address - Country:US
Mailing Address - Phone:573-739-4010
Mailing Address - Fax:573-458-9041
Practice Address - Street 1:3391 COUNTY ROAD 2240
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-8546
Practice Address - Country:US
Practice Address - Phone:573-739-4010
Practice Address - Fax:573-458-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty