Provider Demographics
NPI:1427112697
Name:ELLSTEIN, PAUL CLIFFORD (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CLIFFORD
Last Name:ELLSTEIN
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 1:1011 LAKE ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1148
Mailing Address - Country:US
Mailing Address - Phone:708-848-8122
Mailing Address - Fax:708-848-8109
Practice Address - Street 1:1011 LAKE ST
Practice Address - Street 2:SUITE 407
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1148
Practice Address - Country:US
Practice Address - Phone:708-848-8122
Practice Address - Fax:708-848-8109
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K08769Medicare PIN
ILT38091Medicare UPIN