Provider Demographics
NPI:1487661773
Name:URRUTIA, LISA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2616 COVELL VILLAGE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-9703
Mailing Address - Country:US
Mailing Address - Phone:405-920-6440
Mailing Address - Fax:405-920-6446
Practice Address - Street 1:2616 COVELL VILLAGE DR STE 120
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-9703
Practice Address - Country:US
Practice Address - Phone:405-920-6440
Practice Address - Fax:405-920-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor