Lisa Leigh Pedersen, PHD, D.C.
Individual provider Active NPI Chiropractor · Wilmore, KY
NPI 1821327552 · NPPES record last updated Dec 8, 2009
Key facts
- NPI
- 1821327552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5218 (KY)
- Practice address
- 405 N Lexington Ave
Wilmore, KY 40390-1195 - Phone
- (859) 858-0200
- NPI assigned
- Dec 8, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5218 | KY | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5218 | KY | Yes |
Addresses
Primary practice location
405 N Lexington Ave
Wilmore, KY 40390-1195
Mailing address
405 N Lexington Ave
Wilmore, KY 40390-1195
Phone (859) 858-0200
Other providers in Wilmore, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.