Provider Demographics
NPI:1992871230
Name:LIZANA, ROBERT A (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:LIZANA
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 1:1920 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005
Mailing Address - Country:US
Mailing Address - Phone:504-833-2225
Mailing Address - Fax:504-834-1391
Practice Address - Street 1:2404 EDENBORN AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1817
Practice Address - Country:US
Practice Address - Phone:504-833-2225
Practice Address - Fax:504-832-2253
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1957976Medicaid
LA59442Medicare ID - Type Unspecified
T20084Medicare UPIN