Provider Demographics
NPI:1063810257
Name:LISA E STAUDT DC LLC
Entity type:Organization
Organization Name:LISA E STAUDT DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-934-4484
Mailing Address - Street 1:1401 S WASHINGTON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2425
Mailing Address - Country:US
Mailing Address - Phone:402-934-4484
Mailing Address - Fax:
Practice Address - Street 1:1401 S WASHINGTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2425
Practice Address - Country:US
Practice Address - Phone:402-934-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE350044164Medicare PIN
NEU65856Medicare UPIN