Provider Demographics
NPI:1952322604
Name:POULIOT, NALISA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:NALISA
Middle Name:LOUISE
Last Name:POULIOT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NALISA
Other - Middle Name:LOUISE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4321 NE VIVION RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2838
Mailing Address - Country:US
Mailing Address - Phone:816-453-3331
Mailing Address - Fax:816-453-3331
Practice Address - Street 1:4321 NE VIVION RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2838
Practice Address - Country:US
Practice Address - Phone:816-453-3331
Practice Address - Fax:816-453-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24021014OtherBLUE CROSS AND BLUE SHIEL
MO0009863Medicare ID - Type Unspecified