Provider Demographics
NPI:1629159686
Name:LYONS, THOMAS GERALD (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GERALD
Last Name:LYONS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1752
Mailing Address - Country:US
Mailing Address - Phone:716-689-0766
Mailing Address - Fax:716-689-0767
Practice Address - Street 1:1622 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1752
Practice Address - Country:US
Practice Address - Phone:716-689-0766
Practice Address - Fax:716-689-0767
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009251Medicare ID - Type Unspecified