Provider Demographics
NPI:1437294378
Name:ELLENBURG, MICHAEL (ND, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ELLENBURG
Suffix:
Gender:M
Credentials:ND, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 EAST 82ND AVE SUITE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3159
Mailing Address - Country:US
Mailing Address - Phone:907-344-7775
Mailing Address - Fax:907-522-3114
Practice Address - Street 1:615 E 82ND AVE STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3159
Practice Address - Country:US
Practice Address - Phone:907-344-7775
Practice Address - Fax:907-522-3114
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK48175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath