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NPI Code Detail

MEDICARE: EVAN LAWTON ELLIS DC

MEDICARE: EVAN LAWTON ELLIS 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
1111N00000XChiropractorS04102MD

General Provider Information

NPI Number : 1619646171
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN LAWTON ELLIS DC
Provider Business Mailing Address
First Line : 1122 KENILWORTH DR # 106
Second Line :
City : TOWSON
State : MD
Zip : 21204-2139
Country : US
Telephone Number : 443-901-4200
Fax Number :
Provider Business Practice Location Address
First Line : 1122 KENILWORTH DR STE 109
Second Line :
City : TOWSON
State : MD
Zip : 21204-2141
Country : US
Telephone Number : 443-901-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2021
Last Update Date : 09/08/2021

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Directions to “ EVAN LAWTON ELLIS DC” Practice Location

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