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General NPI Number Information
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NPI Number | 1174760110
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Entity Type | Organization
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Legal Business Name | ELLIS CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 2109 NEW GARDEN RD SUITE B
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City | GREENSBORO
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State | NC
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Zip | 27410-2540
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Country | US
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Telephone | 336-282-4123
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Fax | 336-545-3369
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Provider Business Mailing Address
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Address Line | 2109 NEW GARDEN RD SUITE B
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City | GREENSBORO
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State | NC
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Zip | 27410-2540
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Country | US
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Telephone | 336-282-4123
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Fax | 336-545-3369
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMMY G VERNON
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Credential |
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Telephone | 336-282-4123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3884
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License Number State | NC
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