Healthcare Provider Details

I. General information

NPI: 1255538385
Provider Name (Legal Business Name): LISA IRENE OWEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 W BROWARD BLVD STE 250
PLANTATION FL
33324-2704
US

IV. Provider business mailing address

8430 W BROWARD BLVD STE 250
PLANTATION FL
33324-2704
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-8380
  • Fax: 954-651-6263
Mailing address:
  • Phone: 954-358-0878
  • Fax: 954-435-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number000CH7610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: