Healthcare Provider Details

I. General information

NPI: 1275030827
Provider Name (Legal Business Name): KIRSTIN AINSLEY LYONS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 INDUSTRIAL BLVD STE 108
ELLIJAY GA
30540-3721
US

IV. Provider business mailing address

200 INDUSTRIAL BLVD STE 108
ELLIJAY GA
30540-3721
US

V. Phone/Fax

Practice location:
  • Phone: 706-636-4325
  • Fax:
Mailing address:
  • Phone: 706-636-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO010053
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: