Provider Demographics
NPI:1790709491
Name:BISSETT, CHRISTOPHER L (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:BISSETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 LAGRANDE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-2393
Mailing Address - Country:US
Mailing Address - Phone:352-430-0064
Mailing Address - Fax:352-430-0497
Practice Address - Street 1:314 LAGRANDE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-2393
Practice Address - Country:US
Practice Address - Phone:352-430-0064
Practice Address - Fax:352-430-0497
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88502OtherBCBS
U96202Medicare UPIN
FL88502YMedicare PIN