Provider Demographics
NPI:1689764797
Name:BROUSE, JOHN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:BROUSE
Suffix:
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 1:1104 W HIGH ST
Mailing Address - Street 2:UNIT 4A
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1707
Mailing Address - Country:US
Mailing Address - Phone:814-472-9355
Mailing Address - Fax:814-472-0886
Practice Address - Street 1:1104 W HIGH ST
Practice Address - Street 2:UNIT 4A
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1707
Practice Address - Country:US
Practice Address - Phone:814-472-9355
Practice Address - Fax:814-472-0886
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor