Individual
DR. MATTHEW ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
750 W MARKET ST STE 200, LIMA, OH 45801-4602
(419) 516-6032
(419) 516-4881
Mailing address
750 W MARKET ST, SUITE 200, LIMA, OH 45801-4602
(419) 224-8007
(419) 516-4881
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3567
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383249
ANTHEM BC/BS
OH
05
—
2600662
—
OH
01
—
P00374677
PALMETTO GBA MEDICARE RR
OH
Enumeration date
02/13/2006
Last updated
01/26/2017
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