Healthcare Provider Details

I. General information

NPI: 1578700803
Provider Name (Legal Business Name): KIM J LYONS D.C., N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 CHILDRENS HM BRADFORD RD
GREENVILLE OH
45331-9327
US

IV. Provider business mailing address

5136 CHILDRENS HM BRADFORD RD
GREENVILLE OH
45331-9327
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-0111
  • Fax:
Mailing address:
  • Phone: 937-547-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: