Healthcare Provider Details

I. General information

NPI: 1053307744
Provider Name (Legal Business Name): LYSS CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 WATERBURY CT
GAHANNA OH
43230-5310
US

IV. Provider business mailing address

457 WATERBURY CT
GAHANNA OH
43230-5310
US

V. Phone/Fax

Practice location:
  • Phone: 614-337-1904
  • Fax: 614-337-8599
Mailing address:
  • Phone: 614-337-1904
  • Fax: 614-337-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1088
License Number StateOH

VIII. Authorized Official

Name: DR. ROGER J LYSS
Title or Position: CHIROPRACTOR PRESIDENT
Credential: DC
Phone: 614-337-1904