Provider Demographics
NPI:1386153047
Name:ELLINGWORTH, SEAN PHILLIP (DC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PHILLIP
Last Name:ELLINGWORTH
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12749 MEETING HOUSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7399
Mailing Address - Country:US
Mailing Address - Phone:317-452-5170
Mailing Address - Fax:
Practice Address - Street 1:12749 MEETING HOUSE RD STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7399
Practice Address - Country:US
Practice Address - Phone:317-452-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6409111N00000X
IN08003243A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor