Provider Demographics
NPI:1588940258
Name:ELLIS, WILLIAM IX (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ELLIS
Suffix:IX
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 1:933 E PARK DR
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2738
Mailing Address - Country:US
Mailing Address - Phone:614-578-4306
Mailing Address - Fax:
Practice Address - Street 1:933 E PARK DR
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2738
Practice Address - Country:US
Practice Address - Phone:614-578-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor