Provider Demographics
NPI:1679546733
Name:WHEELER, LISA A (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:WHEELER
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 1:2121 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7409
Mailing Address - Country:US
Mailing Address - Phone:512-942-9728
Mailing Address - Fax:888-529-8898
Practice Address - Street 1:4802 COUNTRY CLUB VW
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3008
Practice Address - Country:US
Practice Address - Phone:713-898-8662
Practice Address - Fax:888-529-8898
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4427962OtherTIN