Provider Demographics
NPI:1366845281
Name:LEARY, LISA PAIGE (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PAIGE
Last Name:LEARY
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 1:391 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3750
Mailing Address - Country:US
Mailing Address - Phone:561-252-1034
Mailing Address - Fax:
Practice Address - Street 1:391 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3750
Practice Address - Country:US
Practice Address - Phone:562-276-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor