Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 702 | VA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 702 | VA |
NPI | 1083798557 |
---|---|
Provider Name | Dr. John Franklin Ellis |
First Address | Weber City, VA 24290-7384 |
Second Address | Weber City, VA 24290-7384 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 12/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T21669 | (02) | VA |