Provider Demographics
NPI:1992889497
Name:MIELCARSKI, LISA N (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:N
Last Name:MIELCARSKI
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 1:8 MOUNTAIN BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-6490
Mailing Address - Country:US
Mailing Address - Phone:678-462-4402
Mailing Address - Fax:770-834-4814
Practice Address - Street 1:624 NEWNAN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3429
Practice Address - Country:US
Practice Address - Phone:770-834-6669
Practice Address - Fax:770-834-4814
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHCMMedicare PIN
GAU93754Medicare UPIN