Provider Demographics
NPI:1679605935
Name:LISA JOST CHIROPRACTOR P C
Entity type:Organization
Organization Name:LISA JOST CHIROPRACTOR P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:JOST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-322-8736
Mailing Address - Street 1:506 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4331
Mailing Address - Country:US
Mailing Address - Phone:563-322-8736
Mailing Address - Fax:
Practice Address - Street 1:506 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4331
Practice Address - Country:US
Practice Address - Phone:563-322-8736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16875Medicare ID - Type UnspecifiedGROUP