Provider Demographics
NPI:1225019532
Name:DEMARCO, LISA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:DEMARCO
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 1:4976 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4616
Mailing Address - Country:US
Mailing Address - Phone:716-586-4000
Mailing Address - Fax:716-586-3999
Practice Address - Street 1:4976 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4651
Practice Address - Country:US
Practice Address - Phone:716-586-4000
Practice Address - Fax:716-586-3999
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63699Medicare UPIN
NY13073BMedicare PIN