Provider Demographics
NPI:1164792784
Name:FOUSE, CASEY MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MAE
Last Name:FOUSE
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 1:3910 CONCORD PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1716
Mailing Address - Country:US
Mailing Address - Phone:302-472-4878
Mailing Address - Fax:302-407-3629
Practice Address - Street 1:3910 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1716
Practice Address - Country:US
Practice Address - Phone:302-472-4878
Practice Address - Fax:302-407-3629
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010547111N00000X
DEF1-0000873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE566674YECBMedicare PIN
PA338310YTBHMedicare PIN