Provider Demographics
NPI:1053781856
Name:KONYNENBELT, LISA (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:KONYNENBELT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PEERBOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5570 WILSON AVE SW STE MN
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-8867
Mailing Address - Country:US
Mailing Address - Phone:616-259-9835
Mailing Address - Fax:
Practice Address - Street 1:5570 WILSON AVE SW
Practice Address - Street 2:STE L
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-8867
Practice Address - Country:US
Practice Address - Phone:616-566-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor