Provider Demographics
NPI:1295580363
Name:ELLISON, MAURICE JAMES WARREN (DC)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:JAMES WARREN
Last Name:ELLISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2506
Mailing Address - Country:US
Mailing Address - Phone:951-737-1252
Mailing Address - Fax:951-737-2820
Practice Address - Street 1:2250 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2506
Practice Address - Country:US
Practice Address - Phone:951-737-1252
Practice Address - Fax:951-737-2820
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor