Provider Demographics
NPI:1447241526
Name:PLESKOVITCH, LYRESA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LYRESA
Middle Name:ANN
Last Name:PLESKOVITCH
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 1:2504 ASH ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1804
Mailing Address - Country:US
Mailing Address - Phone:650-327-0703
Mailing Address - Fax:
Practice Address - Street 1:2504 ASH ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1804
Practice Address - Country:US
Practice Address - Phone:650-327-0703
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0248930Medicare ID - Type Unspecified
CAO248930Medicare UPIN