Healthcare Provider Details

I. General information

NPI: 1922558816
Provider Name (Legal Business Name): KEVIN LYONS L.AC,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JACK MARTIN BLVD
BRICK NJ
08724-7737
US

IV. Provider business mailing address

424 S MAIN ST
FORKED RIVER NJ
08731-4654
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-1020
  • Fax: 732-865-7787
Mailing address:
  • Phone: 609-971-3500
  • Fax: 609-971-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00121600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: