MEDICARE: DR. LISA LONG PALESTRA 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	CH6821	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972548014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA LONG PALESTRA D.C.

Provider Business Mailing Address
First Line	:	4282 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-930-6112
Fax Number	:	813-930-6332

Provider Business Practice Location Address
First Line	:	4282 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-930-6112
Fax Number	:	813-930-6332

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	04/26/2012

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