Provider Demographics
NPI:1104926260
Name:GEURINK, LISA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNN
Last Name:GEURINK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 5TH ST
Mailing Address - Street 2:PO BOX 715
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-0715
Mailing Address - Country:US
Mailing Address - Phone:563-785-6511
Mailing Address - Fax:563-785-6347
Practice Address - Street 1:902 5TH ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747
Practice Address - Country:US
Practice Address - Phone:563-785-6511
Practice Address - Fax:563-785-6347
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
25944OtherBLUE CROSS/ BLUE SHIELD
10590OtherMIDLANDS CHOICE
421352832OtherMARSH ADVANTAGE
IA0104OtherJOHN DEERE HEALTH CARE
P00298398OtherPALMETO GBA/RR MEDIARE
IA0104OtherJOHN DEERE HEALTH CARE
10590OtherMIDLANDS CHOICE