Provider Demographics
NPI:1194747311
Name:SUH, ELLIS M (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:M
Last Name:SUH
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 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:7052 ORANGEWOOD AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1419
Practice Address - Country:US
Practice Address - Phone:714-903-1100
Practice Address - Fax:714-903-1055
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 27541OtherCA. CHIROPRACTIC LICENSE