Provider Demographics
NPI:1386744381
Name:LISKA, DAVID LEYROY (DC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEYROY
Last Name:LISKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-1819
Mailing Address - Country:US
Mailing Address - Phone:620-257-2040
Mailing Address - Fax:620-257-2038
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-1819
Practice Address - Country:US
Practice Address - Phone:620-257-2040
Practice Address - Fax:620-257-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04803111N00000X, 171100000X, 225100000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060953Medicare ID - Type Unspecified
T18567Medicare UPIN