Provider Demographics
NPI:1538228564
Name:CALHOUN, LISA RENEE (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:CALHOUN
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 1:16600 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2219
Mailing Address - Country:US
Mailing Address - Phone:850-230-1288
Mailing Address - Fax:850-230-6122
Practice Address - Street 1:16600 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2219
Practice Address - Country:US
Practice Address - Phone:850-230-1288
Practice Address - Fax:850-230-6122
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6508111N00000X
GACHIR007829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22787ZMedicare ID - Type Unspecified
FLU34016Medicare UPIN