Provider Demographics
NPI:1720287246
Name:ELLIS, CHAD VINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:VINTON
Last Name:ELLIS
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 1:2040 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2963
Mailing Address - Country:US
Mailing Address - Phone:602-938-9000
Mailing Address - Fax:602-493-3208
Practice Address - Street 1:2040 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2963
Practice Address - Country:US
Practice Address - Phone:602-938-9000
Practice Address - Fax:602-493-3208
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor