Provider Demographics
NPI:1851313613
Name:LISBIN, ERIC RALPH (DC LAC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RALPH
Last Name:LISBIN
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST LANCASTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2416
Mailing Address - Country:US
Mailing Address - Phone:610-796-2684
Mailing Address - Fax:
Practice Address - Street 1:300 WEST LANCASTER AVENUE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2416
Practice Address - Country:US
Practice Address - Phone:610-775-7565
Practice Address - Fax:610-775-8442
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004856L111N00000X
PAAK000126L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA703619Medicare ID - Type Unspecified
PA703619Medicare UPIN