Provider Demographics
NPI:1558742403
Name:LYNCH, BEVERLY (LAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-8404
Mailing Address - Country:US
Mailing Address - Phone:321-474-4573
Mailing Address - Fax:321-474-4573
Practice Address - Street 1:1007 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-8404
Practice Address - Country:US
Practice Address - Phone:321-474-4573
Practice Address - Fax:321-269-7838
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-ACU-LIC-27134171100000X
FLAP3845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist