Provider Demographics
NPI:1396957726
Name:THORNHILL, LISA A (LAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770147
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-0147
Mailing Address - Country:US
Mailing Address - Phone:970-846-5602
Mailing Address - Fax:
Practice Address - Street 1:702 OAK STREET
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-846-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1278171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1396957726OtherNPI - UNSURE IF INDIVIDUAL OR ORG-APPLYING FOR WHICHEVER ONE IT IS NOT
CO208976948OtherEIN