Individual
DR. LISA RENE FARIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
4337 FLAGSTAFF CV, FORT WAYNE, IN 46815-4400
(260) 485-9300
Mailing address
4337 FLAGSTAFF CV, FORT WAYNE, IN 46815-4400
(260) 485-9300
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002194A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231870A
MEDICARE GROUP #
IN
Enumeration date
12/20/2006
Last updated
03/09/2018
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