=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710851837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROFUSION PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 5TH ST W
-----------------------------------------------------
City | BOTTINEAU
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58318-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-228-3873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 5TH ST W
-----------------------------------------------------
City | BOTTINEAU
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58318-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-228-3873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. ELIZABETH ELLIS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 701-441-1157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------