Provider Demographics
NPI:1386740199
Name:ELLIS, ELDON L (DC)
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:L
Last Name:ELLIS
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 1:703 N WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-8745
Mailing Address - Country:US
Mailing Address - Phone:913-592-2116
Mailing Address - Fax:913-592-2117
Practice Address - Street 1:703 N WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-8745
Practice Address - Country:US
Practice Address - Phone:913-592-2116
Practice Address - Fax:913-592-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC3234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO02650016OtherBLUE CROSS BLUE SHIELD
KS27203OtherBLUE CROSS BLUE SHIELD
KS0002823Medicare PIN