Provider Demographics
NPI:1215796107
Name:ELLSWORTH, JESSICA (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 LOLA ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8682
Mailing Address - Country:US
Mailing Address - Phone:140-644-9250
Mailing Address - Fax:
Practice Address - Street 1:780 LOLA ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8682
Practice Address - Country:US
Practice Address - Phone:406-449-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor