Provider Demographics
NPI:1114941119
Name:LYONS, CHARLES J (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:LYONS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:505 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-2887
Mailing Address - Country:US
Mailing Address - Phone:248-941-5330
Mailing Address - Fax:586-979-5096
Practice Address - Street 1:36150 DEQUINDRE RD
Practice Address - Street 2:SUITE 730
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7149
Practice Address - Country:US
Practice Address - Phone:586-979-4950
Practice Address - Fax:586-979-5096
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICL007629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3384548Medicaid
MIU70964Medicare UPIN
MI3384548Medicaid