Provider Demographics
NPI:1558767152
Name:LISLE NEWBOLD, JOHANNA G (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:G
Last Name:LISLE NEWBOLD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHANNA
Other - Middle Name:G
Other - Last Name:NEWBOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:71 SPIT BROOK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5636
Mailing Address - Country:US
Mailing Address - Phone:603-791-0222
Mailing Address - Fax:
Practice Address - Street 1:71 SPIT BROOK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5636
Practice Address - Country:US
Practice Address - Phone:603-791-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor