Mountain State Chiropractic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

823 Issued in WV

Legal business name

MOUNTAIN STATE CHIROPRACTIC

Practice address

310 Market St
Man, WV 25635-1321

Phone

(304) 583-6400

NPI assigned

Dec 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Johnathan Matthew Ellis, D.C

Title

Doctor

Phone

(304) 583-6400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan Matthew Ellis, B.S., D.C.

  • Chiropractor
  • Man, WV
  • NPI 1083634026
  NPD (past)
• John White III, DC

  • Chiropractor
  • Man, WV
  • NPI 1760518468
  NPD (past)
• Melissa White, D C

  • Chiropractor
  • Man, WV
  • NPI 1548396724
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366501447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 664",
            "city": "MAN",
            "state": "WV",
            "postal_code": "256350664",
            "telephone_number": "304-583-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 MARKET ST",
            "city": "MAN",
            "state": "WV",
            "postal_code": "256351321",
            "telephone_number": "304-583-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "304-583-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WV",
            "license": "823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0208726000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lincoln County Primary Care Center, Inc.
• Man Rexcellence Program
• Chrissondria Lynn Mangrum, MA, CCC-SLP
• Cheryl Marie Marcum
• Mary Margaret Maynard
• Angela Muncy
• Amberia Shea Nelson
• Carlee Samantha Osborne
• Pioneer Medical Services Inc (Pioneer Medical Services)
• Tiffany Michelle Pullin

• Chiropractor in Man, WV
• Providers in Man, WV by specialty
• Chiropractor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.