Provider Demographics
NPI:1043369283
Name:PRICE, LISA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:PRICE
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 1:31012 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1545
Mailing Address - Country:US
Mailing Address - Phone:586-350-0400
Mailing Address - Fax:
Practice Address - Street 1:31012 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1545
Practice Address - Country:US
Practice Address - Phone:586-350-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E053390OtherBCBSMI
MI0P22790Medicare ID - Type Unspecified