Provider Demographics
NPI:1568461283
Name:REID, LISA PATRICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:PATRICIA
Last Name:REID
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 1:9735 W SAINT MARTINS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9830
Mailing Address - Country:US
Mailing Address - Phone:262-682-4131
Mailing Address - Fax:
Practice Address - Street 1:9735 W SAINT MARTINS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9624
Practice Address - Country:US
Practice Address - Phone:414-525-9895
Practice Address - Fax:414-525-9927
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38911500Medicaid
WI20-0493747014OtherBLUE CROSS/BLUE SHIELD
WI20-0493747014OtherBLUE CROSS/BLUE SHIELD
WI38911500Medicaid