Provider Demographics
NPI:1265947410
Name:BREWKA, ELISE (LAC)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BREWKA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3030
Mailing Address - Country:US
Mailing Address - Phone:216-570-9818
Mailing Address - Fax:
Practice Address - Street 1:23215 COMMERCE PARK STE 102
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5843
Practice Address - Country:US
Practice Address - Phone:216-570-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist