Provider Demographics
NPI:1588651038
Name:LYSYK SMITH, ALA LORA (DC)
Entity Type:Individual
Prefix:
First Name:ALA
Middle Name:LORA
Last Name:LYSYK SMITH
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 1:104 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2123
Mailing Address - Country:US
Mailing Address - Phone:218-736-4113
Mailing Address - Fax:218-998-4337
Practice Address - Street 1:104 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2123
Practice Address - Country:US
Practice Address - Phone:218-736-4113
Practice Address - Fax:218-998-4337
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231892OtherCHIROCARE
MN350046096OtherRAILROAD MEDICARE
MN4C740LYOtherBLUE CROSS/BLUE SHIELD
MN804023100Medicaid
MN231892OtherCHIROCARE
MN350046096OtherRAILROAD MEDICARE