Provider Demographics
NPI:1053490706
Name:BARTLETT, ELIZABETH ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 DIAMOND LN
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-8320
Mailing Address - Country:US
Mailing Address - Phone:630-699-5714
Mailing Address - Fax:630-473-2477
Practice Address - Street 1:953 MONUMENT DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2968
Practice Address - Country:US
Practice Address - Phone:630-699-5714
Practice Address - Fax:630-473-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009605111NI0900X
IN08003268A111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7957448OtherAETNA
IL02232594OtherBCBS OF ILLINOIS
IL3610727OtherCIGNA
IL11562742OtherCAQH
IL697284OtherACN
IL3610727OtherCIGNA
ILK06119Medicare ID - Type Unspecified