Provider Demographics
NPI:1013027911
Name:STEIN, LISA M (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:STEIN
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 1:21730 STEVENS CREEK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1171
Mailing Address - Country:US
Mailing Address - Phone:408-255-2592
Mailing Address - Fax:408-255-9650
Practice Address - Street 1:21730 STEVENS CREEK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1171
Practice Address - Country:US
Practice Address - Phone:408-255-2592
Practice Address - Fax:408-255-9650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0204110Medicare ID - Type Unspecified