Healthcare Provider Details

I. General information

NPI: 1518068337
Provider Name (Legal Business Name): PAUL G. LYELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL G. LYELL D.C.

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 W WALNUT ST STE D
JACKSONVILLE IL
62650-1153
US

IV. Provider business mailing address

1521 W WALNUT ST STE D
JACKSONVILLE IL
62650-1153
US

V. Phone/Fax

Practice location:
  • Phone: 217-243-4333
  • Fax: 217-243-8082
Mailing address:
  • Phone: 217-243-4333
  • Fax: 844-892-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2017018593
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-30710
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38010780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: