MEDICARE: LYKENS CHIROPRACTIC, INC

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	0104555911	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588662563	OTHER	VA	INDIV. PRACTITIONER NPI
2	39606	OTHER	VA	OPTIMA/SENTARA
3	1508815598	OTHER	VA	GROUP NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	192109	OTHER	VA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508815598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYKENS CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	650 CEDAR CREEK GRADE STE 207
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6454
Country	:	US
Telephone Number	:	540-667-7388
Fax Number	:	540-667-4694

Provider Business Practice Location Address
First Line	:	650 CEDAR CREEK GRADE STE 207
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6454
Country	:	US
Telephone Number	:	540-667-7388
Fax Number	:	540-667-4694

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	RONDA N LYKENS
Credential	:	DC
Telephone Number	:	540-667-7388

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/01/2018

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