Provider Demographics
NPI:1013083302
Name:ELLERHOLZ, ALAN LEE (DC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:ELLERHOLZ
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 1:2890 N ADRIAN HWY
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1190
Mailing Address - Country:US
Mailing Address - Phone:517-263-6200
Mailing Address - Fax:
Practice Address - Street 1:2890 N ADRIAN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1190
Practice Address - Country:US
Practice Address - Phone:517-263-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT97163Medicare UPIN
MI0D65025Medicare ID - Type Unspecified