Provider Demographics
NPI:1598804643
Name:KRAWCZUN, LISA MAY (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MAY
Last Name:KRAWCZUN
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 1:902 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4107
Mailing Address - Country:US
Mailing Address - Phone:813-385-4442
Mailing Address - Fax:
Practice Address - Street 1:931 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4935
Practice Address - Country:US
Practice Address - Phone:813-385-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60263Medicare UPIN
FLU7037ZMedicare ID - Type Unspecified