Individual
DANIEL LELAND ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1709 35TH AVE W UNIT 1, SPENCER, IA 51301-2550
(712) 260-0090
Mailing address
1607 MCNAUGHTON WAY, SPENCER, IA 51301-2873
(712) 260-0090
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
514AG2680
IA
Other
Enumeration date
02/18/2022
Last updated
02/18/2022
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