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General NPI Number Information
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NPI Number | 1568704195
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Entity Type | Individual
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Provider Name | LISA MCCULLOUGH D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1822 BLACK LAKE BLVD SW STE 103
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City | OLYMPIA
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State | WA
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Zip | 98512-5628
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Country | US
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Telephone | 360-943-0988
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Fax | 615-264-8879
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Provider Business Mailing Address
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Address Line | 1822 BLACK LAKE BLVD SW STE 103
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City | OLYMPIA
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State | WA
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Zip | 98512-5628
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Country | US
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Telephone | 360-943-0988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2350
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH61009274
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License Number State | WA
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