Provider Demographics
NPI:1467623447
Name:LYONS CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:LYONS CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MECKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-823-6664
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:438 PARK ST
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-0181
Mailing Address - Country:US
Mailing Address - Phone:303-823-6664
Mailing Address - Fax:303-823-6665
Practice Address - Street 1:438 PARK ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540-0181
Practice Address - Country:US
Practice Address - Phone:303-823-6664
Practice Address - Fax:303-823-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO530128Medicare PIN