Healthcare Provider Details

I. General information

NPI: 1891972527
Provider Name (Legal Business Name): ELLIS CHIROPRACTIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
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: 573-739-4010
  • Fax: 573-458-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LYNN ELLIS
Title or Position: OWNER
Credential: D.C.
Phone: 573-739-4010