Ellsworth, Tabitha Robin
Ellsworth, Tabitha Robin is an sole proprietor health care provider with primary practice located at 3701 Nameoki Rd Unit E, Granite City IL 62040-3711. She recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as her primary health care specialty. Ellsworth, Tabitha Robin can be contacted via phone (618) 451-8830.Contact Information
Primary practice address
3701 Nameoki Rd Unit E
Granite City IL 62040-3711
Phone: (618) 451-8830
Fax: (866) 912-2457
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 038.011457 | Illinois |
Profile Details
| NPI number | 1245532068 |
|---|---|
| LBN Legal business name | Ellsworth, Tabitha Robin |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 30th, 2010 |
| Last updated | Dec 10th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245532068 | NPPES |
| Illinois | MEDICAID | 038011457 |
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