Provider Demographics
NPI:1598881203
Name:PANGBURN, LYNN M (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:PANGBURN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:KNUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1830 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 135
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3056
Mailing Address - Country:US
Mailing Address - Phone:480-839-2273
Mailing Address - Fax:480-907-3061
Practice Address - Street 1:1830 S ALMA SCHOOL RD
Practice Address - Street 2:STE 135
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3056
Practice Address - Country:US
Practice Address - Phone:480-839-2273
Practice Address - Fax:480-907-3061
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0402700OtherBCBS
AZ108101Medicare PIN
AZ108101Medicare ID - Type Unspecified
AZAZ0402700OtherBCBS