Provider Demographics
NPI:1932592367
Name:MICHAELS, LISA (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MICHAELS
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 1:504 MAURER ST
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778-9592
Mailing Address - Country:US
Mailing Address - Phone:563-732-3221
Mailing Address - Fax:563-732-2769
Practice Address - Street 1:504 MAURER ST
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778
Practice Address - Country:US
Practice Address - Phone:563-732-3221
Practice Address - Fax:563-732-3221
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor