Provider Demographics
NPI:1336285469
Name:KIND, LISA HUTCHERSON (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:HUTCHERSON
Last Name:KIND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:HUTCHERSON
Other - Last Name:OESTREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10055 FORD AVE
Mailing Address - Street 2:3-C
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3972
Mailing Address - Country:US
Mailing Address - Phone:912-459-1200
Mailing Address - Fax:912-459-1201
Practice Address - Street 1:10055 FORD AVE
Practice Address - Street 2:3-C
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3972
Practice Address - Country:US
Practice Address - Phone:912-459-1200
Practice Address - Fax:912-459-1201
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGGXMedicare ID - Type Unspecified
GAU84364Medicare UPIN