Provider Demographics
NPI:1578660999
Name:PRUSINSKI, LISA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DAWN
Last Name:PRUSINSKI
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 1:3750 SOUTH EVANS ST
Mailing Address - Street 2:STE. C
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5412
Mailing Address - Country:US
Mailing Address - Phone:252-355-1770
Mailing Address - Fax:252-353-1415
Practice Address - Street 1:3750 SOUTH EVANS ST
Practice Address - Street 2:STE. C
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5412
Practice Address - Country:US
Practice Address - Phone:252-355-1770
Practice Address - Fax:252-353-1415
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908221Medicaid
NC2448701AMedicare PIN
NCU47468Medicare UPIN