Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 001531 | CT |
NPI | 1013019462 |
---|---|
Provider Name | Dr. Anthony James Lisi |
First Address | West Haven, CT 06516-2770 |
Second Address | West Haven, CT 06516-2770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U66047 | (02) | CT |