Provider Demographics
NPI:1124152814
Name:RARDIN, LISA ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:RARDIN
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 1:112 NE HAYES ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1048
Mailing Address - Country:US
Mailing Address - Phone:641-743-2756
Mailing Address - Fax:641-343-7308
Practice Address - Street 1:112 NE HAYES ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1048
Practice Address - Country:US
Practice Address - Phone:641-743-2756
Practice Address - Fax:641-343-7308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor