Provider Demographics
NPI:1588731079
Name:ELLIS, DANNY L JR (DC)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:L
Last Name:ELLIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-2485
Mailing Address - Country:US
Mailing Address - Phone:910-862-8544
Mailing Address - Fax:910-862-3569
Practice Address - Street 1:196 N PINE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9245
Practice Address - Country:US
Practice Address - Phone:910-862-8544
Practice Address - Fax:910-862-3569
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790842AMedicaid
NC790842AMedicaid