Provider Demographics
NPI:1326164781
Name:BANDUR, LISA K (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BANDUR
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 1:498 UNIVERSITY BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3721
Mailing Address - Country:US
Mailing Address - Phone:540-433-2638
Mailing Address - Fax:540-433-2637
Practice Address - Street 1:498 UNIVERSITY BLVD STE F
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3721
Practice Address - Country:US
Practice Address - Phone:540-433-2638
Practice Address - Fax:540-433-2637
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7684111N00000X
VA0104556291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU88807Medicare UPIN
FL55994Medicare ID - Type Unspecified