Provider Demographics
NPI:1952943482
Name:VAWTER, LISA (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:VAWTER
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 1:2001 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3332
Mailing Address - Country:US
Mailing Address - Phone:913-221-4157
Mailing Address - Fax:
Practice Address - Street 1:7019 OAK ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2500
Practice Address - Country:US
Practice Address - Phone:913-221-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor