Healthcare Provider Details

I. General information

NPI: 1194831115
Provider Name (Legal Business Name): JOHN LYNN ELLIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 COUNTY ROAD 2240
SALEM MO
65560-8546
US

IV. Provider business mailing address

3391 COUNTY ROAD 2240
SALEM MO
65560-8546
US

V. Phone/Fax

Practice location:
  • Phone: 573-739-4010
  • Fax: 573-458-9041
Mailing address:
  • Phone: 573-729-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006814
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006814
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: