Organization
MOUNTAIN STATE CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNATHAN MATTHEW ELLIS D.C (DOCTOR)
(304) 583-6400
Entity
Organization
Contact information
Practice address
310 MARKET ST, MAN, WV 25635-1321
(304) 583-6400
Mailing address
PO BOX 664, MAN, WV 25635-0664
(304) 583-6400
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
823
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0208726000
—
WV
Enumeration date
12/06/2006
Last updated
08/22/2020
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