Provider Demographics
NPI:1164314852
Name:ROUSE, SUSAN SOPHIA (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SOPHIA
Last Name:ROUSE
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 1:3757 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4225
Mailing Address - Country:US
Mailing Address - Phone:813-220-4158
Mailing Address - Fax:
Practice Address - Street 1:3757 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4225
Practice Address - Country:US
Practice Address - Phone:813-220-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15569111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor