Provider Demographics
NPI:1710066535
Name:FAUST, ELISE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:FAUST
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 1:1163 EATONTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2026
Mailing Address - Country:US
Mailing Address - Phone:706-342-7115
Mailing Address - Fax:
Practice Address - Street 1:1163 EATONTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2026
Practice Address - Country:US
Practice Address - Phone:706-342-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDPDMedicare ID - Type Unspecified