Provider Demographics
NPI:1356508808
Name:SUTHERLAND HAASE, LISA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SUTHERLAND HAASE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SUTHERLAND-HAASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2800 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-3327
Mailing Address - Country:US
Mailing Address - Phone:517-372-3922
Mailing Address - Fax:517-372-3956
Practice Address - Street 1:2800 N EAST ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-3327
Practice Address - Country:US
Practice Address - Phone:517-372-3922
Practice Address - Fax:517-372-3956
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007633111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition