Provider Demographics
NPI:1114171295
Name:PLESA, LISA ANN-LONGOBARDO (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN-LONGOBARDO
Last Name:PLESA
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 1:14015 INDEPENDENCE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:704-882-1448
Practice Address - Street 1:14015 INDEPENDENCE BLVD STE D
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9668
Practice Address - Country:US
Practice Address - Phone:704-882-1488
Practice Address - Fax:704-882-1448
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC3890111N00000X
GACHIR008324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2457502OtherMEDICARE PTAN