Provider Demographics
NPI:1285686493
Name:LYSSY, WAYNE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ANTHONY
Last Name:LYSSY
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 1:112 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3702
Mailing Address - Country:US
Mailing Address - Phone:251-675-5407
Mailing Address - Fax:251-679-9725
Practice Address - Street 1:112 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3702
Practice Address - Country:US
Practice Address - Phone:251-675-5407
Practice Address - Fax:251-679-9725
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51098638Medicare ID - Type Unspecified
ALU42171Medicare UPIN