Provider Demographics
NPI:1225253917
Name:MARSH, LISA (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MARSH
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 1:1114 FLORIDA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4331
Mailing Address - Country:US
Mailing Address - Phone:727-772-1966
Mailing Address - Fax:727-772-0096
Practice Address - Street 1:1114 FLORIDA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4331
Practice Address - Country:US
Practice Address - Phone:727-772-1966
Practice Address - Fax:727-772-0096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor