Provider Demographics
NPI:1245820612
Name:HALLEY, ELLYN (DC)
Entity type:Individual
Prefix:DR
First Name:ELLYN
Middle Name:
Last Name:HALLEY
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 1:2172 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7350
Mailing Address - Country:US
Mailing Address - Phone:920-904-5868
Mailing Address - Fax:
Practice Address - Street 1:2172 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7350
Practice Address - Country:US
Practice Address - Phone:920-904-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WI5605-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No374J00000XNursing Service Related ProvidersDoula