Provider Demographics
NPI:1972652154
Name:KOENIG, LISA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KOENIG
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 1:3645 GRAND AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2040
Mailing Address - Country:US
Mailing Address - Phone:510-547-1494
Mailing Address - Fax:
Practice Address - Street 1:3645 GRAND AVE STE 305
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2040
Practice Address - Country:US
Practice Address - Phone:510-547-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor