Provider Demographics
NPI:1366405862
Name:FIELDS-JACOBSON, LISA (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FIELDS-JACOBSON
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:ROSENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12472-0326
Mailing Address - Country:US
Mailing Address - Phone:845-256-2220
Mailing Address - Fax:
Practice Address - Street 1:169 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1119
Practice Address - Country:US
Practice Address - Phone:845-256-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0057601111N00000X
MECR1527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCBC057606OtherWORKERS COMP
465745ROtherEMPIRE
465745ROtherEMPIRE