Provider Demographics
NPI:1033285291
Name:GRANNIS, LISSA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LISSA
Middle Name:ANN
Last Name:GRANNIS
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 1:6210 75TH ST W
Mailing Address - Street 2:SUITE A100
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8303
Mailing Address - Country:US
Mailing Address - Phone:253-588-1800
Mailing Address - Fax:253-588-8781
Practice Address - Street 1:6210 75TH ST W
Practice Address - Street 2:SUITE A100
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8303
Practice Address - Country:US
Practice Address - Phone:253-588-1800
Practice Address - Fax:253-588-8781
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001748111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health