Jason Max Ellis, D.C.

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

2301008416 Issued in MI

Practice address

4010 Page Ave
Ste 104
Michigan Center, MI 49254-1026

Phone

(248) 489-4044

Fax

(248) 489-4055

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jason M Ellis DC PLLC

  • Nutrition Chiropractor
  • Commerce Township, MI
  • NPI 1750564910
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1366583163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WELCH RD",
            "address_2": "STE 111",
            "city": "COMMERCE TOWNSHIP",
            "state": "MI",
            "postal_code": "483902864",
            "telephone_number": "248-779-9290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 PAGE AVE",
            "address_2": "STE 104",
            "city": "MICHIGAN CENTER",
            "state": "MI",
            "postal_code": "492541026",
            "telephone_number": "248-489-4044",
            "fax_number": "248-489-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JASON",
        "middle_name": "MAX",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "MI",
            "license": "2301008416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nutrition Chiropractor in Michigan Center, MI
• Providers in Michigan Center, MI by specialty
• Nutrition Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.