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NPI Code Detail

MEDICARE: MR. JOSHUA CHARLES ELLIS A.T.C., C.S.C.S.

MEDICARE: MR. JOSHUA CHARLES ELLIS A.T.C., C.S.C.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0107SD

General Provider Information

NPI Number : 1043362247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSHUA CHARLES ELLIS A.T.C., C.S.C.S.
Provider Business Mailing Address
First Line : 509 CITY SPRINGS RD
Second Line : APT 12
City : RAPID CITY
State : SD
Zip : 57702-0155
Country : US
Telephone Number : 605-737-0464
Fax Number :
Provider Business Practice Location Address
First Line : 321 KANSAS CITY ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-2820
Country : US
Telephone Number : 605-394-4860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 07/08/2007

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Directions to “ MR. JOSHUA CHARLES ELLIS A.T.C., C.S.C.S.” Practice Location

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