Provider Demographics
NPI:1891529632
Name:MICHELI-DAWSON, LISA ANTOINETTE (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANTOINETTE
Last Name:MICHELI-DAWSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANTOINETTE
Other - Last Name:MICHELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:28727 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0800
Mailing Address - Country:US
Mailing Address - Phone:310-547-4005
Mailing Address - Fax:310-547-4117
Practice Address - Street 1:28727 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0800
Practice Address - Country:US
Practice Address - Phone:310-547-4005
Practice Address - Fax:310-547-4117
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor