Provider Demographics
NPI:1013947415
Name:VIZZACCO, LISA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:VIZZACCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 OAKLAWN AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2649
Mailing Address - Country:US
Mailing Address - Phone:401-942-6020
Mailing Address - Fax:401-942-6178
Practice Address - Street 1:1255 OAKLAWN AVE STE 2D
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2649
Practice Address - Country:US
Practice Address - Phone:401-942-6020
Practice Address - Fax:401-942-6178
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP000363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU69966Medicare UPIN