MEDICARE: DR. DAVID S ELLIS D.C.

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	3724	OH

General Provider Information

NPI Number	:	1427054204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S ELLIS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-0105
Country	:	US
Telephone Number	:	949-374-3789
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 RANDOLPH ST
Second Line	:	STE B
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2775
Country	:	US
Telephone Number	:	937-382-1095
Fax Number	:	937-382-3739

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

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	07/08/2007

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