Organization
EDISS CHIROPRACTIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE F. LISCO-EDISS (PRESIDENT)
(307) 358-5066
Entity
Organization
Contact information
Practice address
1330 E RICHARDS ST, DOUGLAS, WY 82633-2951
(307) 358-3147
(307) 358-3213
Mailing address
1330 E RICHARDS ST, P.O. BOX 902, DOUGLAS, WY 82633-2951
(307) 358-3147
(307) 358-3213
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
574
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03753001
BCBS CLINIC
—
01
—
0554501
WORKERS COMPENSATION
WY
Enumeration date
12/05/2007
Last updated
01/20/2021
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