Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 465 | LA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 465 | LA |
NPI | 1235208547 |
---|---|
Provider Name | William J Ellender |
First Address | Houma, LA 70364-3112 |
Second Address | Houma, LA 70364-3112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1953318 | (05) | LA |
T20092 | (02) | LA |