Provider Demographics
NPI:1114991478
Name:BELL, LISA JANNELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JANNELLE
Last Name:BELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6585 ROCHESTER RD
Mailing Address - Street 2:STE 107
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-813-0500
Mailing Address - Fax:248-879-8055
Practice Address - Street 1:6585 ROCHESTER RD
Practice Address - Street 2:STE 107
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-813-0500
Practice Address - Fax:248-879-8055
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB008450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86927Medicare UPIN
P20010002Medicare ID - Type Unspecified