Provider Demographics
NPI:1083016869
Name:HOUSE, ELYSE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELYSE
Other - Middle Name:
Other - Last Name:MILITELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1088 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8309
Mailing Address - Country:US
Mailing Address - Phone:716-837-1711
Mailing Address - Fax:716-837-1711
Practice Address - Street 1:1088 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8309
Practice Address - Country:US
Practice Address - Phone:716-837-1711
Practice Address - Fax:716-837-1711
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400285248Medicare PIN