Provider Demographics
NPI:1861586695
Name:ELLIS, DONALD C (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1412 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2124
Mailing Address - Country:US
Mailing Address - Phone:251-621-1842
Mailing Address - Fax:251-432-3438
Practice Address - Street 1:1412 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2124
Practice Address - Country:US
Practice Address - Phone:251-432-3437
Practice Address - Fax:251-432-3438
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU41787Medicare UPIN