Provider Demographics
NPI:1689792004
Name:KUCMA, LISA K (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:KUCMA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:HETRICK-KUCMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4023 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7044
Mailing Address - Country:US
Mailing Address - Phone:919-261-9444
Mailing Address - Fax:919-261-9470
Practice Address - Street 1:4023 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7044
Practice Address - Country:US
Practice Address - Phone:919-261-9444
Practice Address - Fax:919-261-9470
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085V8OtherBCBSNC
NC5902485Medicaid