Provider Demographics
NPI:1396750808
Name:PATENODE, LISA (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:PATENODE
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 1:4690 SW HALL BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0562
Mailing Address - Country:US
Mailing Address - Phone:503-352-4193
Mailing Address - Fax:503-536-6822
Practice Address - Street 1:4690 SW HALL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0562
Practice Address - Country:US
Practice Address - Phone:503-352-4193
Practice Address - Fax:503-536-6822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV04811Medicare UPIN