MEDICARE: DR. LISA ANN THRASH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10950	TX
2	111N00000X	Chiropractor	1332	AR

General Provider Information

NPI Number	:	1396713863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANN THRASH D.C.

Provider Business Mailing Address
First Line	:	11025 ARBOR WOOD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77705-4425
Country	:	US
Telephone Number	:	409-886-7246
Fax Number	:	409-886-1219

Provider Business Practice Location Address
First Line	:	2315 N 16TH ST
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-2329
Country	:	US
Telephone Number	:	409-886-7246
Fax Number	:	409-886-1219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	08/20/2020

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