MEDICARE: IXCHEL PAGAN LMT

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	225700000X	Massage Therapist	227.023784	IL

General Provider Information

NPI Number	:	1922962331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IXCHEL PAGAN LMT

Provider Business Mailing Address
First Line	:	125 WILSON AVE
Second Line	:
City	:	MACHESNEY PARK
State	:	IL
Zip	:	61115-2362
Country	:	US
Telephone Number	:	779-217-7020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 E STATE ST STE 2
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2165
Country	:	US
Telephone Number	:	779-217-7020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ IXCHEL PAGAN LMT” Practice Location

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