Provider Demographics
NPI:1467461517
Name:GREGUSON-PUPPE, ELIZABETH PAULINE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PAULINE
Last Name:GREGUSON-PUPPE
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 1:319 E HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-2047
Mailing Address - Country:US
Mailing Address - Phone:320-243-7551
Mailing Address - Fax:320-243-7571
Practice Address - Street 1:319 E HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-2047
Practice Address - Country:US
Practice Address - Phone:320-243-7551
Practice Address - Fax:320-243-7571
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C022GROtherBCBS PROVIDER NUMBER
MN3C022GROtherBCBS PROVIDER NUMBER