Provider Demographics
NPI:1689815631
Name:ELLIS, ASHLEY (DN)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10406 S TROY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2024
Mailing Address - Country:US
Mailing Address - Phone:773-426-5096
Mailing Address - Fax:
Practice Address - Street 1:10406 S TROY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2024
Practice Address - Country:US
Practice Address - Phone:773-426-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000358172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath