Provider Demographics
NPI:1235196734
Name:SANDERS, LISA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1525 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2260
Mailing Address - Country:US
Mailing Address - Phone:618-943-4949
Mailing Address - Fax:618-943-5858
Practice Address - Street 1:1525 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2260
Practice Address - Country:US
Practice Address - Phone:618-943-4949
Practice Address - Fax:618-943-5858
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL900141448OtherFEIN
IL05132005OtherBLUE CROSS BLUE SHEILDPIN
IL660547OtherHEALTHLINK PIN
ILK06649Medicare ID - Type Unspecified