Provider Demographics
NPI:1194867531
Name:CARLET, LISA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:CARLET
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 1:314 E MOUNTAIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2988
Mailing Address - Country:US
Mailing Address - Phone:970-420-9196
Mailing Address - Fax:
Practice Address - Street 1:314 E MOUNTAIN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2988
Practice Address - Country:US
Practice Address - Phone:970-420-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor