Provider Demographics
NPI:1396771143
Name:ELLIN, MICHAEL WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:ELLIN
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 1:8004 LINCOLN DR W
Mailing Address - Street 2:SUITE F
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3213
Mailing Address - Country:US
Mailing Address - Phone:856-810-1030
Mailing Address - Fax:856-810-2236
Practice Address - Street 1:8004 LINCOLN DR W
Practice Address - Street 2:SUITE F
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3213
Practice Address - Country:US
Practice Address - Phone:856-810-1030
Practice Address - Fax:856-810-2236
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00435500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJEL607441Medicare ID - Type Unspecified
NJU57508Medicare UPIN