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General NPI Number Information
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NPI Number | 1659617090
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Entity Type | Organization
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Legal Business Name | THOMAS P ELLIS DC PA
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 214 PASADENA AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33707-1251
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Country | US
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Telephone | 727-341-1234
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Fax | 727-345-0843
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Provider Business Mailing Address
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Address Line | 214 PASADENA AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33707-1251
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Country | US
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Telephone | 727-341-1234
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Fax | 727-345-0843
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS PAUL ELLIS
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Credential | D.C.
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Telephone | 727-341-1234
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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 | CH00004294
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License Number State | FL
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