Provider Demographics
NPI:1699961896
Name:CHRISTOPHER RICHARD ELLERAAS
Entity type:Organization
Organization Name:CHRISTOPHER RICHARD ELLERAAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ELLERAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-792-9000
Mailing Address - Street 1:3830 VALLEY CENTRE DR
Mailing Address - Street 2:SUITE #704
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3320
Mailing Address - Country:US
Mailing Address - Phone:858-792-9000
Mailing Address - Fax:858-792-9001
Practice Address - Street 1:3830 VALLEY CENTRE DR
Practice Address - Street 2:SUITE #704
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3320
Practice Address - Country:US
Practice Address - Phone:858-792-9000
Practice Address - Fax:858-792-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTOPHER ELLERAAS, D.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-20
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24348Medicare PIN