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General NPI Number Information
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NPI Number | 1740310432
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Entity Type | Organization
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Legal Business Name | ELLYSON CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 605 E STREET
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City | MARYSVILLE
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State | CA
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Zip | 95901
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Country | US
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Telephone | 530-743-2093
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Fax | 530-743-3301
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Provider Business Mailing Address
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Address Line | 605 E STREET
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City | MARYSVILLE
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State | CA
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Zip | 95901
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Country | US
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Telephone | 530-743-2093
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Fax | 530-743-3301
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAVID S ELLYSON
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Credential | DC
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Telephone | 530-743-2093
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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 | 29895
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License Number State | CA
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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 | 11189
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 29423
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License Number State | CA
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