Provider Demographics
NPI:1871613505
Name:MISIAK, LISA MERRITT (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MERRITT
Last Name:MISIAK
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 1:3912 OAK ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9552
Mailing Address - Country:US
Mailing Address - Phone:585-589-9344
Mailing Address - Fax:585-589-1178
Practice Address - Street 1:3912 OAK ORCHARD RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9552
Practice Address - Country:US
Practice Address - Phone:585-589-9344
Practice Address - Fax:585-589-1178
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007977-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106038ANOtherPREFERRED CARE
NY106038ANOtherPREFERRED CARE
NYU65177Medicare UPIN