Healthcare Provider Details

I. General information

NPI: 1083837462
Provider Name (Legal Business Name): LISA DEANNE DIAMOND CHIRO. ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18945 FM 2252 SUITE 115
SAN ANTONIO TX
78266-2562
US

IV. Provider business mailing address

2102 NW AUSTIN DR
LAWTON OK
73505-3209
US

V. Phone/Fax

Practice location:
  • Phone: 210-651-0027
  • Fax: 210-651-0029
Mailing address:
  • Phone: 580-351-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: