Provider Demographics
NPI:1477678209
Name:LYNDEN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LYNDEN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUXON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-318-0123
Mailing Address - Street 1:P.O. BOX 388
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264
Mailing Address - Country:US
Mailing Address - Phone:360-318-0123
Mailing Address - Fax:360-318-0424
Practice Address - Street 1:105-5TH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264
Practice Address - Country:US
Practice Address - Phone:360-318-0123
Practice Address - Fax:360-318-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty