Provider Demographics
NPI:1013062280
Name:EISENBEISZ, LORI J (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:EISENBEISZ
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 1:3043 MAIN ST.
Mailing Address - Street 2:P.O. BOX 305
Mailing Address - City:BOWDLE
Mailing Address - State:SD
Mailing Address - Zip Code:57428
Mailing Address - Country:US
Mailing Address - Phone:605-285-6944
Mailing Address - Fax:605-285-6941
Practice Address - Street 1:3043 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOWDLE
Practice Address - State:SD
Practice Address - Zip Code:57428
Practice Address - Country:US
Practice Address - Phone:605-285-6944
Practice Address - Fax:605-285-6941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD817111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601210Medicaid
SD7601210Medicaid