Doctor Name: | DR. TABITHA ROBIN ELLSWORTH |
NPI Number: | 1245532068 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | 038.011457 |
Business Practice Address: | 3701 Nameoki Rd Unit E Granite City, IL - 620403711 |
Business Phone Number: | 6184518830 |
Business Fax Number: | 8669122457 |
Mailing Address: | 3701 Nameoki Rd, Unit E GRANITE CITY |
State: | IL |
Postal Code: | 620403711 |
Phone Number: | 6184518830 |
Fax Number: | 8669122457 |
NPI Enumeration Date: | 11/30/2010 |
NPI Last Update Date: | 12/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 038.011457 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |