MEDICARE: DR. ROBERT J LYONS D.C.

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	111N00000X	Chiropractor	2373	TN
2	111N00000X	Chiropractor	2301009800	MI

General Provider Information

NPI Number	:	1255666970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J LYONS D.C.

Provider Business Mailing Address
First Line	:	4110 COPPER RIDGE DR
Second Line	:	STE. 210
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6722
Country	:	US
Telephone Number	:	231-943-2229
Fax Number	:	231-943-2231

Provider Business Practice Location Address
First Line	:	4110 COPPER RIDGE DR
Second Line	:	STE. 210
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6722
Country	:	US
Telephone Number	:	231-943-2229
Fax Number	:	231-943-2231

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

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	05/13/2015

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