Provider Demographics
NPI:1265579486
Name:PATT, LISA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:PATT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4800 MEXICO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:314-690-1525
Mailing Address - Fax:636-246-0446
Practice Address - Street 1:4800 MEXICO RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:314-690-1525
Practice Address - Fax:636-246-0446
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1738059OtherTAX IDENTIFICATION NUMBER
MO2006033498OtherSTATE LICENSE NUMBER
MO705076OtherUHC
MO7603897OtherAETNA
MO298105OtherGHP