Individual
DR. ELISHA BLACKMAR VAN DEUSEN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
17220 NEWHOPE ST, SUITE 123, FOUNTAIN VALLEY, CA 92708-4272
(714) 556-6966
(714) 556-6967
Mailing address
17220 NEWHOPE ST, SUITE 123, FOUNTAIN VALLEY, CA 92708-4272
(714) 556-6966
(714) 556-6967
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC28866
CA
Other
Enumeration date
08/14/2006
Last updated
04/17/2015
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