Ellis Chiropractic Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

860 Issued in ID

Legal business name

ELLIS CHIROPRACTIC INC

Practice address

745 W Bridge St Ste F
Blackfoot, ID 83221-2000

Phone

(208) 782-9793

Fax

(208) 782-1999

NPI assigned

Sep 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Valden J Ellis, D.O.NPI 1689627978

Title

Owner

Phone

(208) 782-9793

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Valden J Ellis, D.C.

  • Chiropractor
  • Blackfoot, ID
  • NPI 1689627978

  ID

  Medicare reassignment Care Compare group Authorized official
• Kade Keck, DC

  • Chiropractor
  • Shelley, ID
  • NPI 1346838232
  Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1043406705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 W. BRIDGE ST. SUITE F",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "83221",
            "telephone_number": "208-782-9793",
            "fax_number": "208-782-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 W BRIDGE ST STE F",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212000",
            "telephone_number": "208-782-9793",
            "fax_number": "208-782-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "VALDEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-782-9793",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawna Durbin
• Jennifer Lynn Durham, MA
• Eagle River Organization, Ind
• East Idaho Anesthesia Associates PC
• Elizabeth Kenette Ellin, NBC-HIS
• Sadie Ellis, DPT
• Valden J Ellis, D.C.
• Debra Erramouspe, PA
• Travis Ray Evans, FNP
• Matthew J Fackrell, DO

• All providers in Blackfoot, ID
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.