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General NPI Number Information
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NPI Number | 1053307744
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Entity Type | Organization
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Legal Business Name | LYSS CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 457 WATERBURY CT
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City | GAHANNA
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State | OH
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Zip | 43230-5310
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Country | US
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Telephone | 614-337-1904
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Fax | 614-337-8599
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Provider Business Mailing Address
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Address Line | 457 WATERBURY CT
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City | GAHANNA
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State | OH
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Zip | 43230-5310
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Country | US
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Telephone | 614-337-1904
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Fax | 614-337-8599
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Authorized Official
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Title or Position | CHIROPRACTOR PRESIDENT
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Name | DR. ROGER J LYSS
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Credential | DC
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Telephone | 614-337-1904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1088
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License Number State | OH
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