Provider Demographics
NPI:1508990680
Name:LYONS, DANIEL DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DONALD
Last Name:LYONS
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 1:2920 SOUTH WEBSTER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2801
Mailing Address - Country:US
Mailing Address - Phone:920-347-4884
Mailing Address - Fax:920-347-4878
Practice Address - Street 1:2920 SOUTH WEBSTER
Practice Address - Street 2:SUITE 100
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2801
Practice Address - Country:US
Practice Address - Phone:920-347-4884
Practice Address - Fax:920-347-4878
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 3306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38966500Medicaid
WI75147Medicare PIN
WI38966500Medicaid