MEDICARE: JESSICA ELLSWORTH DC

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
1	111N00000X	Chiropractor	8724	MT

General Provider Information

NPI Number	:	1215796107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ELLSWORTH DC

Provider Business Mailing Address
First Line	:	780 LOLA ST
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-8682
Country	:	US
Telephone Number	:	140-644-9250
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 LOLA ST
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-8682
Country	:	US
Telephone Number	:	406-449-2501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “ JESSICA ELLSWORTH DC” Practice Location

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