Provider Demographics
NPI:1568897825
Name:DILLON, LISA LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:DILLON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1301
Mailing Address - Country:US
Mailing Address - Phone:217-784-8888
Mailing Address - Fax:
Practice Address - Street 1:113 W 8TH ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1301
Practice Address - Country:US
Practice Address - Phone:217-784-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist