Provider Demographics
NPI:1821372152
Name:DAVID L. LISKA DC PA
Entity Type:Organization
Organization Name:DAVID L. LISKA DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:LISKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-257-2040
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-1819
Mailing Address - Country:US
Mailing Address - Phone:620-257-2040
Mailing Address - Fax:620-257-2038
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-1819
Practice Address - Country:US
Practice Address - Phone:620-257-2040
Practice Address - Fax:620-257-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060953OtherMEDICARE ID
KS060953OtherMEDICARE ID