Provider Demographics
NPI:1225083934
Name:BISESI, KAREN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNN
Last Name:BISESI
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 1:75 EXECUTIVE DR STE J
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2993
Mailing Address - Country:US
Mailing Address - Phone:317-580-0000
Mailing Address - Fax:317-927-8621
Practice Address - Street 1:75 EXECUTIVE DR STE J
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2993
Practice Address - Country:US
Practice Address - Phone:317-580-0000
Practice Address - Fax:317-927-8621
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN080001647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200088760Medicaid
IN352022568OtherTAX ID
IN352022568OtherTAX ID
IN318760Medicare ID - Type Unspecified