Provider Demographics
NPI:1972800720
Name:BOUSE, ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:BOUSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:AZHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3008 E STATE ROAD 32
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8729
Mailing Address - Country:US
Mailing Address - Phone:317-867-0123
Mailing Address - Fax:317-867-3636
Practice Address - Street 1:3008 E STATE ROAD 32
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8729
Practice Address - Country:US
Practice Address - Phone:317-867-0123
Practice Address - Fax:317-867-3636
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002567A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation