Provider Demographics
NPI:1912022567
Name:SHEFCHIK, LISA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RAE
Last Name:SHEFCHIK
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 1:2525 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4838
Mailing Address - Country:US
Mailing Address - Phone:920-429-2844
Mailing Address - Fax:
Practice Address - Street 1:2525 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4838
Practice Address - Country:US
Practice Address - Phone:920-429-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4298-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor