Provider Demographics
NPI:1235927930
Name:ELLSWORTH CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:ELLSWORTH CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-273-4115
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-0668
Mailing Address - Country:US
Mailing Address - Phone:715-273-4115
Mailing Address - Fax:715-273-6546
Practice Address - Street 1:187 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-9188
Practice Address - Country:US
Practice Address - Phone:715-273-4115
Practice Address - Fax:715-273-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty