Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3860-12 | WI |
NPI | 1003064783 |
---|---|
Provider Name | Dr. Brookh Susan Lyonns |
First Address | Green Bay, WI 54301-1594 |
Second Address | Green Bay, WI 54301-1594 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 05/09/2008 |