Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00001748 | WA |
N | 111NX0100X | Occupational Health | CH00001748 | WA |
NPI | 1033285291 |
---|---|
Provider Name | Dr. Lissa Ann Grannis |
First Address | Lakewood, WA 98499-8303 |
Second Address | Lakewood, WA 98499-8303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |