Provider Demographics
NPI:1588748206
Name:VACHON, LISA RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:VACHON
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 1:971 CHESTNUT HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:FT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814
Mailing Address - Country:US
Mailing Address - Phone:260-625-6511
Mailing Address - Fax:260-625-6711
Practice Address - Street 1:971 CHESTNUT HILLS PKWY
Practice Address - Street 2:
Practice Address - City:FT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814
Practice Address - Country:US
Practice Address - Phone:260-625-6511
Practice Address - Fax:260-625-6711
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002124A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98877Medicare UPIN
IN207290BMedicare PIN