Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2826 | OH |
NPI | 1043376783 |
---|---|
Provider Name | Dr. Michael C Lyons |
First Address | Boardman, OH 44513 |
Second Address | Boardman, OH 44512-7325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 02/01/2015 |