Provider Demographics
NPI:1558475624
Name:ASTON, LISA LORANGER (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LORANGER
Last Name:ASTON
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 1:125 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2719
Mailing Address - Country:US
Mailing Address - Phone:313-383-1615
Mailing Address - Fax:734-697-8102
Practice Address - Street 1:125 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2719
Practice Address - Country:US
Practice Address - Phone:313-383-1615
Practice Address - Fax:734-697-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950H251850OtherBCBS
H25185001Medicare PIN
950H251850OtherBCBS