Provider Demographics
NPI:1205977816
Name:HOMIC, LISA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:HOMIC
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 1:144 GENESEE ST STE 102102
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3503
Mailing Address - Country:US
Mailing Address - Phone:315-277-1362
Mailing Address - Fax:
Practice Address - Street 1:22 STATE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3625
Practice Address - Country:US
Practice Address - Phone:315-277-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9832OtherWORKERS COMP
NY9832OtherWORKERS COMP