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General NPI Number Information
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NPI Number | 1598841256
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Entity Type | Individual
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Provider Name | ROSEANNE DISHMAN ELLIS DC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 135 W JACKSON ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-3927
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Country | US
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Telephone | 931-528-8362
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Fax | 931-528-8657
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Provider Business Mailing Address
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Address Line | 135 W JACKSON ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-3927
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Country | US
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Telephone | 931-528-8362
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Fax | 931-528-8657
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC430
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 104000516
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License Number State | VA
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