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General NPI Number Information
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NPI Number | 1740686955
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Entity Type | Organization
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Legal Business Name | LISLE NEWBOLD ENTERPRISES PLLC
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Dates
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Enumeration Date | 11/16/2014
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Last Update Date | 11/16/2014
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Provider Practice Location Address
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Address Line | 71 SPIT BROOK RD 108
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City | NASHUA
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State | NH
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Zip | 03060-5636
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Country | US
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Telephone | 603-791-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 71 SPIT BROOK RD 108
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City | NASHUA
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State | NH
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Zip | 03060-5636
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Country | US
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Telephone | 603-791-0222
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHANNA GATES LISLE NEWBOLD
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Credential | DC
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Telephone | 603-791-0222
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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 | 956
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License Number State | NH
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