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NPI Code Detail

MEDICARE: LISA SPIRIT MATTESON LMT

MEDICARE:   LISA SPIRIT MATTESON  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NR0400XRehabilitation Chiropractor7793NM

General Provider Information

NPI Number : 1235524356
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA SPIRIT MATTESON LMT
Provider Business Mailing Address
First Line : 13509 COPPER AVE NE APT 4
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87123-1746
Country : US
Telephone Number : 505-269-8542
Fax Number :
Provider Business Practice Location Address
First Line : 13509 COPPER AVE NE APT 4
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87123-1746
Country : US
Telephone Number : 505-269-8542
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2015
Last Update Date : 04/06/2015

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Directions to “ LISA SPIRIT MATTESON LMT” Practice Location

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