| Organization Name: | ELLINGSON CHIROPRACTIC CLINIC, PC |
| NPI Number: | 1710251384 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRUCE PAUL ELLINGSON (OWNER) |
| Mailing Address: | 140 3rd St N Waite Park |
| State: | MN US |
| Postal Code: | 563871206 |
| Phone Number: | 3202513828 |
| Fax Number: | 3202584481 |
| NPI Enumeration Date: | 02/29/2012 |
| NPI Last Update Date: | 02/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2703 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |