Provider Demographics
NPI:1295910560
Name:KOUZES, LISA ANNE LOSEKE (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE LOSEKE
Last Name:KOUZES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:LOSEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4690 SW HALL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0562
Mailing Address - Country:US
Mailing Address - Phone:503-972-5601
Mailing Address - Fax:503-972-5603
Practice Address - Street 1:4690 SW HALL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-972-5601
Practice Address - Fax:503-972-5603
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3727111N00000X
OR713727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor