Healthcare Provider Details

I. General information

NPI: 1336434539
Provider Name (Legal Business Name): LISA MARIE MONSIVAIS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MARIE MONSIVAIS DC

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13956 US HIGHWAY 87 S
ADKINS TX
78101-1900
US

IV. Provider business mailing address

13956 US HIGHWAY 87 S
ADKINS TX
78101-1900
US

V. Phone/Fax

Practice location:
  • Phone: 210-471-9661
  • Fax:
Mailing address:
  • Phone: 210-471-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: