Individual
LISA M PROVENZA-TABAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
3680 STARRS CENTRE DR, CANFIELD, OH 44406-9514
(330) 702-0500
(330) 705-0575
Mailing address
3680 STARRS CENTRE DR, CANFIELD, OH 44406-9514
(330) 702-0500
(330) 702-0575
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2661
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2062888
—
OH
01
—
341935351-00
BWC
OH
Enumeration date
10/28/2005
Last updated
06/11/2008
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