Provider Demographics
NPI:1699203166
Name:WILLIAMS, LISA MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:WILLIAMS
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 1:1770 TIMBERWOOD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7501
Mailing Address - Country:US
Mailing Address - Phone:434-218-2620
Mailing Address - Fax:
Practice Address - Street 1:1770 TIMBERWOOD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7501
Practice Address - Country:US
Practice Address - Phone:434-218-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor