Individual
DR. MARK T ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC PT
Contact information
Practice address
761 LAKELAND CT, CARMEL, IN 46032-1205
(317) 418-0285
Mailing address
761 LAKELAND CT, CARMEL, IN 46032-1205
(317) 418-0285
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001711A
IN
225100000X
Physical Therapist
05005146A
IN
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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