Provider Demographics
NPI:1588850028
Name:CONNORS, LISA MARIE (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:CONNORS
Suffix:
Gender:M
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COLD SPRING RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3160
Mailing Address - Country:US
Mailing Address - Phone:860-529-6260
Mailing Address - Fax:
Practice Address - Street 1:35 COLD SPRING RD
Practice Address - Street 2:SUITE 124
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3160
Practice Address - Country:US
Practice Address - Phone:860-529-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT35800002Medicare PIN