Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11539 | TX |
N | 111NP0017X | Pediatric Chiropractor | 11539 | TX |
NPI | 1093020083 |
---|---|
Provider Name | Dr. Lisa O'neill Ellis |
First Address | Richardson, TX 75081-4103 |
Second Address | Richardson, TX 75081-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 13/08/2010 |