Provider Demographics
NPI:1760714745
Name:BROWN, LISA S (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:BROWN
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 1:3705 S. MACDILL AVE.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611
Mailing Address - Country:US
Mailing Address - Phone:813-832-3611
Mailing Address - Fax:
Practice Address - Street 1:3705 S. MACDILL AVE.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611
Practice Address - Country:US
Practice Address - Phone:813-832-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7160111N00000X
SC1693111N00000X
NJ38MC00446900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor