MEDICARE: ELLIS HEALTH CENTER INC

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	3267	OK

General Provider Information

NPI Number	:	1679799308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIS HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	243 HERITAGE
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2089
Country	:	US
Telephone Number	:	580-657-2225
Fax Number	:	580-657-2235

Provider Business Practice Location Address
First Line	:	243 HERITAGE ST
Second Line	:
City	:	LONE GROVE
State	:	OK
Zip	:	73443
Country	:	US
Telephone Number	:	580-657-2225
Fax Number	:	580-657-2235

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS CHARLES ELLIS
Credential	:	D.C.
Telephone Number	:	580-657-2225

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/25/2023

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Directions to “ELLIS HEALTH CENTER INC ” Practice Location

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