MEDICARE: DR. LYLE H ABBAS DC ACUPUNCTURIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	02940	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00307	OTHER	IN	WELLMARK BCBS

General Provider Information

NPI Number	:	1881689958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYLE H ABBAS DC ACUPUNCTURIST

Provider Business Mailing Address
First Line	:	211 S 8TH ST
Second Line	:
City	:	CLEAR LAKE
State	:	IA
Zip	:	50428-1909
Country	:	US
Telephone Number	:	641-357-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 S 8TH ST
Second Line	:
City	:	CLEAR LAKE
State	:	IA
Zip	:	50428-1909
Country	:	US
Telephone Number	:	641-357-1636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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