Provider Demographics
NPI:1013017664
Name:HEWITT, ELISE G (DC, CST, DICCP)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:G
Last Name:HEWITT
Suffix:
Gender:F
Credentials:DC, CST, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1649
Mailing Address - Country:US
Mailing Address - Phone:503-224-2100
Mailing Address - Fax:503-224-2129
Practice Address - Street 1:2031 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1649
Practice Address - Country:US
Practice Address - Phone:503-224-2100
Practice Address - Fax:503-224-2129
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2473111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor