Provider Demographics
NPI:1073694816
Name:LYMAN, BRIAN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:LYMAN
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 1:585 W 100 N
Mailing Address - Street 2:STE E
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9876
Mailing Address - Country:US
Mailing Address - Phone:435-750-6909
Mailing Address - Fax:435-750-6909
Practice Address - Street 1:585 W 100 N
Practice Address - Street 2:STE E
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9876
Practice Address - Country:US
Practice Address - Phone:435-750-6909
Practice Address - Fax:435-750-6909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295371-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT86070061777001OtherBLUE CROSS BLUE SHIELD
10034OtherALTIUS HEALTH PLANS
UT870395551LY1OtherEMIA
UT39158OtherPEHP
UTU32217Medicare UPIN