Provider Demographics
NPI:1952182545
Name:ELLSWORTH, AUSTIN COLE (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:COLE
Last Name:ELLSWORTH
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 1:2955 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4227
Mailing Address - Country:US
Mailing Address - Phone:419-473-2955
Mailing Address - Fax:
Practice Address - Street 1:2955 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4227
Practice Address - Country:US
Practice Address - Phone:419-473-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1932119559OtherNPI GROUP
OH2316774Medicaid