Provider Demographics
NPI:1851752190
Name:BRADEN, LISA NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:BRADEN
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 1:101 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-1352
Mailing Address - Country:US
Mailing Address - Phone:330-482-2556
Mailing Address - Fax:330-482-3114
Practice Address - Street 1:101 E PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1352
Practice Address - Country:US
Practice Address - Phone:330-482-2556
Practice Address - Fax:330-482-3114
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor