Provider Demographics
NPI:1043376783
Name:LYONS, MICHAEL C (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:LYONS
Suffix:
Gender:M
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:P.O. BOX 3351
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44513
Mailing Address - Country:US
Mailing Address - Phone:330-726-7404
Mailing Address - Fax:330-729-9166
Practice Address - Street 1:755 BOARDMAN CANFIELD RD STE P1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-7325
Practice Address - Country:US
Practice Address - Phone:330-726-7404
Practice Address - Fax:330-729-9166
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2826111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0877763Medicare PIN