Provider Demographics
NPI:1104113133
Name:ELLINGSON CHIROPRACTIC AND WELLNESS INC.
Entity type:Organization
Organization Name:ELLINGSON CHIROPRACTIC AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-469-7300
Mailing Address - Street 1:19550 S HARLEM AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-6724
Mailing Address - Country:US
Mailing Address - Phone:815-469-7300
Mailing Address - Fax:815-469-7360
Practice Address - Street 1:19550 S HARLEM AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-6724
Practice Address - Country:US
Practice Address - Phone:815-469-7300
Practice Address - Fax:815-469-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty