Provider Demographics
NPI:1356847842
Name:LISOWE, RHONDA K (DC)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:K
Last Name:LISOWE
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 1:2500 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3277
Mailing Address - Country:US
Mailing Address - Phone:864-367-6766
Mailing Address - Fax:
Practice Address - Street 1:2500 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3277
Practice Address - Country:US
Practice Address - Phone:864-367-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC.4114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor