MEDICARE: BRIAN P LYNCH 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	2713	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00359783	OTHER	OR	RAILROAD MEDICARE I.D.

General Provider Information

NPI Number	:	1689792343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN P LYNCH D.C.

Provider Business Mailing Address
First Line	:	178 PARK ST
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-4224
Country	:	US
Telephone Number	:	541-258-8151
Fax Number	:	541-259-1626

Provider Business Practice Location Address
First Line	:	178 PARK ST
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-4224
Country	:	US
Telephone Number	:	541-258-8151
Fax Number	:	541-259-1626

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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