Provider Demographics
NPI:1003019803
Name:DAVID K. ROUSE, D.C., P.A.
Entity Type:Organization
Organization Name:DAVID K. ROUSE, D.C., P.A.
Other - Org Name:ROUSE CHIROPRACTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KING
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-743-6700
Mailing Address - Street 1:2711 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3235
Mailing Address - Country:US
Mailing Address - Phone:904-743-6700
Mailing Address - Fax:904-745-9101
Practice Address - Street 1:2711 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3235
Practice Address - Country:US
Practice Address - Phone:904-743-6700
Practice Address - Fax:904-745-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05766Medicaid
FL89874OtherBCBS
FL283900OtherAVMED
FL4284579OtherAETNA
FL05766Medicaid
FLCM1378Medicare ID - Type Unspecified