Provider Demographics
NPI:1033166343
Name:LYKENS-SMITH, BRANDI LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LYNN
Last Name:LYKENS-SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1321
Mailing Address - Country:US
Mailing Address - Phone:814-768-7331
Mailing Address - Fax:814-768-7362
Practice Address - Street 1:512 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1321
Practice Address - Country:US
Practice Address - Phone:814-768-7331
Practice Address - Fax:814-768-7362
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA007987L111N00000X
PAAJ008597111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015212750001Medicaid
PABC/BSOtherBLUE CROSS/BLUE SHIELD #
PABC/BSOtherBLUE CROSS/BLUE SHIELD #
PAU84301Medicare UPIN