Provider Demographics
NPI:1245369883
Name:DIGIA LEVENSHUS, LOUISE (DC)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:DIGIA LEVENSHUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:M
Other - Last Name:DIGIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:89 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3235
Mailing Address - Country:US
Mailing Address - Phone:201-444-6656
Mailing Address - Fax:201-445-8686
Practice Address - Street 1:89 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3235
Practice Address - Country:US
Practice Address - Phone:201-444-6656
Practice Address - Fax:201-445-8686
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00306300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5004608Medicaid
520318Medicare ID - Type Unspecified