Provider Demographics
NPI:1215017348
Name:LIDDLE, LISA SIGLER (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SIGLER
Last Name:LIDDLE
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 1:716 ANDERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-2148
Mailing Address - Country:US
Mailing Address - Phone:864-338-7766
Mailing Address - Fax:
Practice Address - Street 1:716 ANDERSON ST STE B
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-2148
Practice Address - Country:US
Practice Address - Phone:864-338-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2063Medicaid