Provider Demographics
NPI:1043433667
Name:KLINE, LISA ANN (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KLINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HUBER HAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:719 EAST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:BEAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17813
Mailing Address - Country:US
Mailing Address - Phone:570-658-2424
Mailing Address - Fax:570-658-2400
Practice Address - Street 1:719 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:BEAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:17813
Practice Address - Country:US
Practice Address - Phone:570-658-2424
Practice Address - Fax:570-658-2400
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005996L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor