Provider Demographics
NPI:1821327552
Name:PEDERSEN, LISA LEIGH (PHD, DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LEIGH
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PHD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1195
Mailing Address - Country:US
Mailing Address - Phone:859-858-0200
Mailing Address - Fax:
Practice Address - Street 1:405 N LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1195
Practice Address - Country:US
Practice Address - Phone:859-858-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor