Provider Demographics
NPI:1881730638
Name:HUBERT, LISA (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:HUBERT
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 1:1105 BURGUNDY LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4107
Mailing Address - Country:US
Mailing Address - Phone:636-527-5853
Mailing Address - Fax:
Practice Address - Street 1:1016 S SERVICE RD W
Practice Address - Street 2:
Practice Address - City:FORISTELL
Practice Address - State:MO
Practice Address - Zip Code:63348-1462
Practice Address - Country:US
Practice Address - Phone:314-852-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor