Healthcare Provider Details

I. General information

NPI: 1821094004
Provider Name (Legal Business Name): BILLY RAY LYON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/22/2006

III. Provider practice location address

7231 PALM AVE
HIGHLAND CA
92346-3262
US

IV. Provider business mailing address

7231 PALM AVE
HIGHLAND CA
92346-3262
US

V. Phone/Fax

Practice location:
  • Phone: 909-862-8888
  • Fax: 909-864-5951
Mailing address:
  • Phone: 909-862-8888
  • Fax: 909-864-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: