Provider Demographics
NPI:1255673273
Name:SAHAR, LISA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SAHAR
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 1:260 RUSSELL BLVD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3839
Mailing Address - Country:US
Mailing Address - Phone:530-574-4135
Mailing Address - Fax:
Practice Address - Street 1:260 RUSSELL BLVD
Practice Address - Street 2:SUITE D-2
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3839
Practice Address - Country:US
Practice Address - Phone:530-574-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26840111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist