Provider Demographics
NPI:1356471668
Name:CATTARULLA, LISA TABICK (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:TABICK
Last Name:CATTARULLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:TABICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11550 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4540
Mailing Address - Country:US
Mailing Address - Phone:678-297-0901
Mailing Address - Fax:678-297-0903
Practice Address - Street 1:11550 JONES BRIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4540
Practice Address - Country:US
Practice Address - Phone:678-297-0901
Practice Address - Fax:678-297-0903
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFFZMedicare ID - Type UnspecifiedGRP3189