MEDICARE: JASON M ELLIS DC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	2301008416	MI

General Provider Information

NPI Number	:	1750564910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON M ELLIS DC PLLC

Provider Business Mailing Address
First Line	:	1001 WELCH RD STE 111
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-2864
Country	:	US
Telephone Number	:	248-779-9290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 WELCH RD STE 111
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-2864
Country	:	US
Telephone Number	:	248-779-9290
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JASON MAX ELLIS
Credential	:	D.C.
Telephone Number	:	248-489-4044

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/10/2020

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