MEDICARE: DR. EDWARD ELLIS JR. ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	113	NH

General Provider Information

NPI Number	:	1437552429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD ELLIS JR. ND

Provider Business Mailing Address
First Line	:	174 CONCORD ST STE 250
Second Line	:
City	:	PETERBOROUGH
State	:	NH
Zip	:	03458-1222
Country	:	US
Telephone Number	:	603-722-8244
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 CONCORD ST STE 250
Second Line	:
City	:	PETERBOROUGH
State	:	NH
Zip	:	03458-1222
Country	:	US
Telephone Number	:	603-722-8244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	12/01/2014

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