Provider Demographics
NPI:1356628143
Name:D'ERAMO, LISA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:D'ERAMO
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 1:4 WALKER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1351
Mailing Address - Country:US
Mailing Address - Phone:630-734-3454
Mailing Address - Fax:
Practice Address - Street 1:4 WALKER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1351
Practice Address - Country:US
Practice Address - Phone:630-734-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009449111N00000X
MI2301007167111N00000X
OH2235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU66711Medicare UPIN