Provider Demographics
NPI:1629134325
Name:MCHUGH, LISA ANN (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MCHUGH
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 1:5093 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:JENNERS
Mailing Address - State:PA
Mailing Address - Zip Code:15546-9617
Mailing Address - Country:US
Mailing Address - Phone:814-629-5581
Mailing Address - Fax:814-629-8020
Practice Address - Street 1:5093 FRONT STREET
Practice Address - Street 2:
Practice Address - City:JENNERS
Practice Address - State:PA
Practice Address - Zip Code:15546-9617
Practice Address - Country:US
Practice Address - Phone:814-629-5581
Practice Address - Fax:814-629-8020
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005326L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMC742900Medicare ID - Type Unspecified