MEDICARE: LYONS CHIROPRACTIC CLINIC

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

General Provider Information

NPI Number	:	1316142094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYONS CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	5649 COVENTRY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7145
Country	:	US
Telephone Number	:	260-436-6565
Fax Number	:	260-459-1130

Provider Business Practice Location Address
First Line	:	5649 COVENTRY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7145
Country	:	US
Telephone Number	:	260-436-6565
Fax Number	:	260-459-1130

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	PERRY L LYONS
Credential	:	D.C.
Telephone Number	:	260-436-6565

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	02/27/2015

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