Provider Demographics
NPI:1841530326
Name:KROLL, LISA DANIELLE (DC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DANIELLE
Last Name:KROLL
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 1:158 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3227
Mailing Address - Country:US
Mailing Address - Phone:845-554-8660
Mailing Address - Fax:
Practice Address - Street 1:158 DANBURY RD STE 3
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3200
Practice Address - Country:US
Practice Address - Phone:203-431-7779
Practice Address - Fax:203-894-5014
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor