Healthcare Provider Details

I. General information

NPI: 1235208547
Provider Name (Legal Business Name): WILLIAM J ELLENDER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7835 PARK AVE
HOUMA LA
70364-3112
US

IV. Provider business mailing address

7835 PARK AVE
HOUMA LA
70364-3112
US

V. Phone/Fax

Practice location:
  • Phone: 985-851-0104
  • Fax: 985-872-4639
Mailing address:
  • Phone: 985-851-0104
  • Fax: 985-872-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number465
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number465
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: