Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | PA007987L | PA |
N | 111NS0005X | Chiropractic Sports Physician | AJ008597 | PA |
NPI | 1033166343 |
---|---|
Provider Name | Dr. Brandi Lynn Lykens-Smith |
First Address | Clearfield, PA 16830-1321 |
Second Address | Clearfield, PA 16830-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1015212750001 | (05) | PA |
BC/BS | BLUE CROSS/BLUE SHIELD # (01) | PA |
U84301 | (02) | PA |