Provider Demographics
NPI:1033232491
Name:PETE, LISA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RAE
Last Name:PETE
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 1:16 JANE ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-1921
Mailing Address - Country:US
Mailing Address - Phone:212-995-5525
Mailing Address - Fax:212-253-2788
Practice Address - Street 1:16 JANE ST
Practice Address - Street 2:APT #1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1921
Practice Address - Country:US
Practice Address - Phone:212-995-5525
Practice Address - Fax:212-253-2788
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor