Tabitha Robin Ellsworth, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038.011457 Issued in IL

Practice address

3701 Nameoki Rd
Unit E
Granite City, IL 62040-3711

Phone

(618) 451-8830

Fax

(866) 912-2457

NPI assigned

Nov 30, 2010

Last updated

Dec 10, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Granite City Chiropractic LLC

  • Chiropractor
  • Granite City, IL
  • NPI 1528072451
  NPD (past)

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1245532068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 NAMEOKI RD",
            "address_2": "UNIT E",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403711",
            "telephone_number": "618-451-8830",
            "fax_number": "866-912-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 NAMEOKI RD",
            "address_2": "UNIT E",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403711",
            "telephone_number": "618-451-8830",
            "fax_number": "866-912-2457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "TABITHA",
        "middle_name": "ROBIN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-30",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.011457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038011457",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mark Eavenson, DC
• Emergency Department Associates, P.C.
• Lori Epley, LMSW
• Evercare at Stearns LLC
• Evercare of Granite City LLC
• Fairview Heights Medical Group SC (Alton Urological Associates Granite City)

• Chiropractor in Granite City, IL
• Providers in Granite City, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.