Provider Demographics
NPI:1891855821
Name:ALLAIRE, LISA MARIA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:ALLAIRE
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 1:254 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2265
Mailing Address - Country:US
Mailing Address - Phone:650-576-3039
Mailing Address - Fax:
Practice Address - Street 1:436 PENINSULA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1680
Practice Address - Country:US
Practice Address - Phone:650-737-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25301111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation