Provider Demographics
NPI:1750137782
Name:WISE, ELIZABETH A (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:WISE
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 1:24106 NW 54TH TER
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-4270
Mailing Address - Country:US
Mailing Address - Phone:352-231-3813
Mailing Address - Fax:
Practice Address - Street 1:507 NW 60TH ST STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6027
Practice Address - Country:US
Practice Address - Phone:352-271-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor