Healthcare Provider Details

I. General information

NPI: 1740166131
Provider Name (Legal Business Name): KAITLYN LEIGH ELLIS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CYPRESS POINT PKWY
PALM COAST FL
32164-8426
US

IV. Provider business mailing address

145 CYPRESS POINT PKWY
PALM COAST FL
32164-8426
US

V. Phone/Fax

Practice location:
  • Phone: 720-270-9895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: