Healthcare Provider Details

I. General information

NPI: 1821372152
Provider Name (Legal Business Name): DAVID L. LISKA DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 02/13/2012
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

VIII. Authorized Official

Name: DR. DAVID L LISKA
Title or Position: OWNER
Credential: DC
Phone: 620-257-2040