Provider Demographics
NPI:1932899705
Name:THOMAS, LISA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THOMAS
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 1:3647 ROYAL MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4828
Mailing Address - Country:US
Mailing Address - Phone:818-324-6111
Mailing Address - Fax:
Practice Address - Street 1:3647 ROYAL MEADOW RD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4828
Practice Address - Country:US
Practice Address - Phone:818-324-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor