Provider Demographics
NPI:1427054204
Name:ELLIS, DAVID S (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-0105
Mailing Address - Country:US
Mailing Address - Phone:949-374-3789
Mailing Address - Fax:
Practice Address - Street 1:24 RANDOLPH ST
Practice Address - Street 2:STE B
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2775
Practice Address - Country:US
Practice Address - Phone:937-382-1095
Practice Address - Fax:937-382-3739
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor