Provider Demographics
NPI:1417039033
Name:BROUSE, THOMAS R III (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:BROUSE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 OLD ROUTE 220 N
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8302
Mailing Address - Country:US
Mailing Address - Phone:814-695-3303
Mailing Address - Fax:
Practice Address - Street 1:1642 OLD ROUTE 220 N
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8302
Practice Address - Country:US
Practice Address - Phone:814-695-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0073971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC0073971OtherSTATE LICENSE
PADC0073971OtherSTATE LICENSE