Provider Demographics
NPI:1710355524
Name:DESPINOSSE, ELISABETH (CCPA)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:DESPINOSSE
Suffix:
Gender:F
Credentials:CCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6108
Mailing Address - Country:US
Mailing Address - Phone:954-584-2488
Mailing Address - Fax:954-584-5257
Practice Address - Street 1:1120 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-6108
Practice Address - Country:US
Practice Address - Phone:954-584-2488
Practice Address - Fax:954-584-5257
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCI345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor