Provider Demographics
NPI:1912086463
Name:COWLEY, LISA BETH (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
Last Name:COWLEY
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 1:44600 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971
Mailing Address - Country:US
Mailing Address - Phone:631-765-1216
Mailing Address - Fax:631-765-6138
Practice Address - Street 1:44600 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971
Practice Address - Country:US
Practice Address - Phone:631-765-1216
Practice Address - Fax:631-765-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT53186Medicare UPIN
NYX30101Medicare PIN