Provider Demographics
NPI:1790878338
Name:YANNI, LISA ALICE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ALICE
Last Name:YANNI
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 1:9003 HAVENSIGHT MALL
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:304-774-4346
Mailing Address - Fax:
Practice Address - Street 1:9003 HAVENSIGHT MALL
Practice Address - Street 2:SUITE 304
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:304-774-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI63111NS0005X
NC2834111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085PEOtherBCBS
NC89085PEMedicaid
NC2456727Medicare PIN
NC89085PEMedicaid