Provider Demographics
NPI:1083984231
Name:LYONS, STEPHANIE SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SUE
Last Name:LYONS
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 1:213 BORDER RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-9643
Mailing Address - Country:US
Mailing Address - Phone:402-910-6937
Mailing Address - Fax:
Practice Address - Street 1:2102 OTRANTO BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9841
Practice Address - Country:US
Practice Address - Phone:843-569-2225
Practice Address - Fax:843-863-1830
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1704111N00000X
SC3825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor