Provider Demographics
NPI:1588919831
Name:LISA A. L. KOUZES, DC
Entity type:Organization
Organization Name:LISA A. L. KOUZES, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A L
Authorized Official - Last Name:KOUZES
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:503-972-5601
Mailing Address - Street 1:9115 SW OLESON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6876
Mailing Address - Country:US
Mailing Address - Phone:503-972-5601
Mailing Address - Fax:503-972-5603
Practice Address - Street 1:9115 SW OLESON RD STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6876
Practice Address - Country:US
Practice Address - Phone:503-972-5601
Practice Address - Fax:503-972-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty