Provider Demographics
NPI:1811977101
Name:STAUDT, LISA E (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:STAUDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:E
Other - Last Name:YOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7808 MAUI CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5644
Mailing Address - Country:US
Mailing Address - Phone:402-339-8188
Mailing Address - Fax:402-593-0310
Practice Address - Street 1:1225 PAPILLION DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5708
Practice Address - Country:US
Practice Address - Phone:402-593-9930
Practice Address - Fax:402-593-0310
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE440088OtherUNITED HEALTH CARE
NE36690OtherBCBS
NE36690OtherBCBS
NE36690OtherBCBS
NE$$$$$$$$$Medicaid