Healthcare Provider Details

I. General information

NPI: 1386744381
Provider Name (Legal Business Name): DAVID LEYROY LISKA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MAIN ST
LYONS KS
67554-1819
US

IV. Provider business mailing address

400 W MAIN ST
LYONS KS
67554-1819
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-2040
  • Fax: 620-257-2038
Mailing address:
  • Phone: 620-257-2040
  • Fax: 620-257-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number04803
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number04803
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04803
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number04803
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: