Provider Demographics
NPI:1306219068
Name:ELLSWORTH, ABIGAIL (ND, LAC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 CARLSON RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-8712
Mailing Address - Country:US
Mailing Address - Phone:231-930-8007
Mailing Address - Fax:
Practice Address - Street 1:218 7TH ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9055
Practice Address - Country:US
Practice Address - Phone:231-492-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0115294175F00000X
MI5402000089171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath