Provider Demographics
NPI:1306017546
Name:ISAAC, ELIZABETH ANNE (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:ISAAC
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 1:11733 LAKE AVE
Mailing Address - Street 2:#9
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2065
Mailing Address - Country:US
Mailing Address - Phone:469-955-5529
Mailing Address - Fax:
Practice Address - Street 1:11860 CLIFTON BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2000
Practice Address - Country:US
Practice Address - Phone:216-521-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3878111N00000X
TX10795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor