Healthcare Provider Details

I. General information

NPI: 1760287122
Provider Name (Legal Business Name): ZACHARY ELLIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 CONGRESS ST # 1
PORTLAND ME
04102-2715
US

IV. Provider business mailing address

959 CONGRESS ST # 1
PORTLAND ME
04102-2715
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-5600
  • Fax:
Mailing address:
  • Phone: 207-699-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCR3078
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: