Provider Demographics
NPI:1407926884
Name:LYON, RICHARD THAD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THAD
Last Name:LYON
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 1:521 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2346
Mailing Address - Country:US
Mailing Address - Phone:401-781-3374
Mailing Address - Fax:
Practice Address - Street 1:521 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2346
Practice Address - Country:US
Practice Address - Phone:401-781-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007551111NN0400X
RIDCP00601111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04506397OtherBLUE CROSS BLUE SHIELD
IL04506397OtherBLUE CROSS BLUE SHIELD
ILU452540Medicare UPIN