Provider Demographics
NPI:1376075853
Name:LISA MEYERSON ACUPUNCTURE
Entity Type:Organization
Organization Name:LISA MEYERSON ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MEYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:773-517-7187
Mailing Address - Street 1:PO BOX 5760
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-5760
Mailing Address - Country:US
Mailing Address - Phone:773-517-7187
Mailing Address - Fax:
Practice Address - Street 1:1234 SHERMAN AVENUE
Practice Address - Street 2:LIGHTHOUSE YOGA AND ACUPUNCTURE
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:773-517-7187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty