Provider Demographics
NPI:1831105717
Name:ELLINGSON, TODD ARNOLD (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ARNOLD
Last Name:ELLINGSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 S HARLEM AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-6724
Mailing Address - Country:US
Mailing Address - Phone:815-469-7300
Mailing Address - Fax:815-469-7360
Practice Address - Street 1:19550 S HARLEM AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-6724
Practice Address - Country:US
Practice Address - Phone:815-469-7300
Practice Address - Fax:815-469-7360
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9921605OtherBC/BS PROVIDER ID
IL350047217Medicare ID - Type UnspecifiedMEDICARE RAILROAD NUMBER
IL9921605OtherBC/BS PROVIDER ID
IL315860Medicare ID - Type UnspecifiedMEDICARE ID