Provider Demographics
NPI:1619969300
Name:LYDY, PATRICIA DIANE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DIANE
Last Name:LYDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:WILLIAMS-LYDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1329 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1217
Mailing Address - Country:US
Mailing Address - Phone:419-683-1298
Mailing Address - Fax:419-683-4023
Practice Address - Street 1:1329 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1217
Practice Address - Country:US
Practice Address - Phone:419-683-1298
Practice Address - Fax:419-683-4023
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9268941OtherMEDICARE GROUP
OHCJ2891OtherRAILROAD MEDICARE GROUP N
OHT47693OtherPIN
OH0231029OtherMEDICAID GROUP NUMBER
OH0501291Medicaid
OH0501291Medicaid