Individual
CHASTON J ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 581-7951
Mailing address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 581-7951
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
12994417-1204
UT
Other
Enumeration date
03/29/2021
Last updated
08/22/2022
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