Individual
COLE G. ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4490 FANUEL ST, #D, SAN DIEGO, CA 92109-4292
(858) 274-9116
(858) 274-9161
Mailing address
4490 FANUEL ST, #D, SAN DIEGO, CA 92109-8737
(858) 274-9116
(858) 274-9161
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC29817
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC18323A
LICENSE
CA
Enumeration date
03/07/2007
Last updated
04/03/2012
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