Organization Name: | MOUNTAIN STATE CHIROPRACTIC |
NPI Number: | 1366501447 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHNATHAN MATTHEW ELLIS (DOCTOR) |
Mailing Address: | 310 Market St Man |
State: | WV US |
Postal Code: | 256351321 |
Phone Number: | 3045836400 |
Fax Number: | |
NPI Enumeration Date: | 12/06/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 823 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
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. |