Provider Demographics
NPI:1578700803
Name:LYONS, KIM J (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:J
Last Name:LYONS
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 CHILDRENS HM BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9327
Mailing Address - Country:US
Mailing Address - Phone:937-547-0111
Mailing Address - Fax:
Practice Address - Street 1:5136 CHILDRENS HM BRADFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-9327
Practice Address - Country:US
Practice Address - Phone:937-547-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor