Healthcare Provider Details

I. General information

NPI: 1083798557
Provider Name (Legal Business Name): JOHN FRANKLIN ELLIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/12/2020
Certification Date: 04/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2368 US HIGHWAY 23 N STE 102
WEBER CITY VA
24290-7384
US

IV. Provider business mailing address

2368 US HIGHWAY 23 N STE 102
WEBER CITY VA
24290-7384
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-6666
  • Fax: 276-386-6666
Mailing address:
  • Phone: 276-386-6666
  • Fax: 276-386-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number702
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: