Provider Demographics
NPI:1376853903
Name:PORTERA-PERRY, LISA M (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:PORTERA-PERRY
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 1:1299 NEWELL HILL PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5230
Mailing Address - Country:US
Mailing Address - Phone:925-683-8478
Mailing Address - Fax:
Practice Address - Street 1:1299 NEWELL HILL PL STE 102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5230
Practice Address - Country:US
Practice Address - Phone:925-683-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-17
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA16815111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition