Individual
DR. JONATHAN MATTHEW ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S., D.C.
Contact information
Practice address
123 MARKET ST, MAN, WV 25635-1216
(304) 688-1204
Mailing address
123 MARKET ST, MAN, WV 25635-1216
(304) 688-1204
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
823
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001705988
BLUE CROSS/ BLUE SHEILD
WV
01
—
1067067
WORKER'S COMP
WV
01
—
113708911
4-MOST
WV
01
—
11378911
STARMARK
WV
01
—
13708911
CIGNA
WV
05
—
3810001425
—
WV
01
—
92064
UNICARE
WV
Enumeration date
07/20/2006
Last updated
09/18/2023
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