Provider Demographics
NPI:1568659373
Name:LYNCH FAMILY CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:LYNCH FAMILY CHIROPRACTIC CLINIC PC
Other - Org Name:SANTIAM CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-367-6163
Mailing Address - Street 1:920 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-1512
Mailing Address - Country:US
Mailing Address - Phone:541-367-6163
Mailing Address - Fax:541-367-1425
Practice Address - Street 1:920 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-1512
Practice Address - Country:US
Practice Address - Phone:541-367-6163
Practice Address - Fax:541-367-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1770640682OtherINDIVIDUAL NPI
ORR115194Medicare PIN
OR1770640682OtherINDIVIDUAL NPI