MEDICARE: JEFFREY R LYNE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	2193	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023000791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY R LYNE DC

Provider Business Mailing Address
First Line	:	1633 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1839
Country	:	US
Telephone Number	:	608-837-7712
Fax Number	:	608-825-6638

Provider Business Practice Location Address
First Line	:	1633 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1839
Country	:	US
Telephone Number	:	608-837-7712
Fax Number	:	608-825-6638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	11/08/2012

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Directions to “ JEFFREY R LYNE DC” Practice Location

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