Basic Information
| Provider Information | |||||||||
| NPI: | 1265579486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATT | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 MEXICO RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146901525 | ||||||||
| FaxNumber: | 6362460446 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 MEXICO RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146901525 | ||||||||
| FaxNumber: | 6362460446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2006033498 | MO | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 43-1738059 | 01 | MO | TAX IDENTIFICATION NUMBER | OTHER | 2006033498 | 01 | MO | STATE LICENSE NUMBER | OTHER | 705076 | 01 | MO | UHC | OTHER | 7603897 | 01 | MO | AETNA | OTHER | 298105 | 01 | MO | GHP | OTHER |