Provider Demographics
NPI:1558581751
Name:ISPHORDING, LISA DAWN (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:ISPHORDING
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 1:3310 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2031
Mailing Address - Country:US
Mailing Address - Phone:216-476-1700
Mailing Address - Fax:
Practice Address - Street 1:3310 WARREN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2031
Practice Address - Country:US
Practice Address - Phone:216-476-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8634111N00000X
OH4032111N00000X
MI2301009585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70058Medicare UPIN