Provider Demographics
NPI:1255650040
Name:PATEL, LISA J (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:PATEL
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 1:334 CRESTWATER TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1524
Mailing Address - Country:US
Mailing Address - Phone:408-464-0333
Mailing Address - Fax:
Practice Address - Street 1:15015 WESTHEIMER RD.
Practice Address - Street 2:STE. K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-606-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107532Medicare PIN