Provider Demographics
NPI:1083754071
Name:LAWHORN, LISA RENAE (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENAE
Last Name:LAWHORN
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2911
Mailing Address - Country:US
Mailing Address - Phone:916-481-9961
Mailing Address - Fax:916-481-9962
Practice Address - Street 1:3575 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-2911
Practice Address - Country:US
Practice Address - Phone:916-481-9961
Practice Address - Fax:916-481-9962
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0257380Medicare ID - Type Unspecified