Provider Demographics
NPI:1548309081
Name:POTTHOFF, ELLEN CLAIRE (DC, ND)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CLAIRE
Last Name:POTTHOFF
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 PARKDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6025
Mailing Address - Country:US
Mailing Address - Phone:925-603-7300
Mailing Address - Fax:925-229-2645
Practice Address - Street 1:6528 PARKDALE PLZ
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6025
Practice Address - Country:US
Practice Address - Phone:925-603-7300
Practice Address - Fax:925-229-2645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor