MEDICARE: DR. CHRISTOPHER LEE ELLIS DC, MS

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	111N00000X	Chiropractor	2032	LA

General Provider Information

NPI Number	:	1477368777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER LEE ELLIS DC, MS

Provider Business Mailing Address
First Line	:	1658 BENTON RD STE 100
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3513
Country	:	US
Telephone Number	:	318-491-4659
Fax Number	:	318-497-7414

Provider Business Practice Location Address
First Line	:	1658 BENTON RD STE 100
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3513
Country	:	US
Telephone Number	:	318-491-4659
Fax Number	:	318-497-7414

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

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/19/2025

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