Provider Demographics
NPI:1417064247
Name:LYKINS, MICHELLE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:LYKINS
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 1:1811 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4236
Mailing Address - Country:US
Mailing Address - Phone:804-741-4433
Mailing Address - Fax:804-741-4857
Practice Address - Street 1:1811 RAINTREE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4236
Practice Address - Country:US
Practice Address - Phone:804-741-4433
Practice Address - Fax:804-741-4857
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000673111N00000X
VA3550111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000238Medicare ID - Type Unspecified