Provider Demographics
NPI:1235486259
Name:SHANE J LYNCH DC LLC
Entity Type:Organization
Organization Name:SHANE J LYNCH DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-223-3811
Mailing Address - Street 1:214 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2205
Mailing Address - Country:US
Mailing Address - Phone:802-223-3811
Mailing Address - Fax:802-223-3598
Practice Address - Street 1:214 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2205
Practice Address - Country:US
Practice Address - Phone:802-223-3811
Practice Address - Fax:802-223-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty