Provider Demographics
NPI:1578705596
Name:DR. LISA PIEROTTI HEALTHSOURCE CHIROPRACTIC AND NUTRITION, INC.
Entity Type:Organization
Organization Name:DR. LISA PIEROTTI HEALTHSOURCE CHIROPRACTIC AND NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:PIEROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-802-8700
Mailing Address - Street 1:1168 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5001
Mailing Address - Country:US
Mailing Address - Phone:650-802-8700
Mailing Address - Fax:650-802-8712
Practice Address - Street 1:1168 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5001
Practice Address - Country:US
Practice Address - Phone:650-802-8700
Practice Address - Fax:650-802-8712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29148111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801921648OtherINDIVIDUAL NPI NUMBER, NOT CORPORATION
CAU99224Medicare UPIN