Joshua Jay Ellenbogen, DC
Individual provider Active NPI Chiropractor · Dunkirk, MD
NPI 1578596458 · NPPES record last updated Jul 18, 2019
Key facts
- NPI
- 1578596458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- S01815 (MD)
- Practice address
- 10339 Southern Maryland Blvd Ste 207
Dunkirk, MD 20754-3018 - Phone
- (410) 286-8330
- Fax
- (410) 286-8332
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S01815 | MD | MD | Chiropractor |
| 01819 | MD | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Pain and Spine Services, LLC | Past |
Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/19122/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | S01815 | MD | Yes |
Addresses
Primary practice location
10339 Southern Maryland Blvd Ste 207
Dunkirk, MD 20754-3018
Mailing address
PO Box 351
Dunkirk, MD 20754-0351
Phone (410) 286-8330
Other providers in Dunkirk, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.