MEDICARE: DR. ELIZABETH ANNE EMERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4344	WI

General Provider Information

NPI Number	:	1730376484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANNE EMERSON D.C.

Provider Business Mailing Address
First Line	:	8499 STATE HIGHWAY 42
Second Line	:
City	:	FISH CREEK
State	:	WI
Zip	:	54212-9419
Country	:	US
Telephone Number	:	920-868-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	8499 STATE HIGHWAY 42
Second Line	:
City	:	FISH CREEK
State	:	WI
Zip	:	54212-9419
Country	:	US
Telephone Number	:	920-868-9280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	05/05/2010

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