Active NPI
Christopher Michal Ellbogen, M.T.
- Massage Therapist
- Naperville, IL
National Provider Identifier
1831218056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 552 S Washington St
Suite 117
Naperville, IL 60540-6658 - Phone
- (630) 961-9636
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | IL | Primary |
Addresses
Primary practice location
552 S Washington St
Suite 117
Naperville, IL 60540-6658
Mailing address
1418 Whitespire CT
Naperville, IL 60565-2031
Phone (630) 961-9636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227003323 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831218056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1418 WHITESPIRE CT",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605652031",
"telephone_number": "630-961-9636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "552 S WASHINGTON ST",
"address_2": "SUITE 117",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605406658",
"telephone_number": "630-961-9636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLBOGEN",
"first_name": "CHRISTOPHER",
"middle_name": "MICHAL",
"name_prefix": "Mr.",
"credential": "M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.