Provider Demographics
NPI:1740318849
Name:CORRON, LISA (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:CORRON
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 1:724 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4201
Mailing Address - Country:US
Mailing Address - Phone:207-332-1235
Mailing Address - Fax:207-593-8900
Practice Address - Street 1:724 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4201
Practice Address - Country:US
Practice Address - Phone:207-332-1235
Practice Address - Fax:207-593-8900
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1351564OtherAETNA
098110OtherANTHEM
098110OtherANTHEM
MM8751Medicare PIN
098110OtherANTHEM