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General NPI Number Information
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NPI Number | 1851543680
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Entity Type | Organization
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Legal Business Name | LYSNE CHIROPRACTIC CARE S.C.
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 222 CHRISTY ST
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City | AMHERST
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State | WI
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Zip | 54406-9390
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Country | US
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Telephone | 715-824-2121
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Fax | 715-824-2123
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | AMHERST
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State | WI
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Zip | 54406-0027
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Country | US
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Telephone | 715-824-2121
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Fax | 715-824-2123
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. MARSHALL TOLMAN LYSNE
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Credential | D.C.
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Telephone | 715-824-2121
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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 | 1281-012
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License Number State | WI
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