Provider Demographics
NPI:1629296975
Name:LYNXWILER, BILLY K (DC)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:K
Last Name:LYNXWILER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:B
Other - Last Name:LYNXWILER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2499B HIGHWAY 62 412
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9459
Mailing Address - Country:US
Mailing Address - Phone:870-856-2718
Mailing Address - Fax:870-856-2719
Practice Address - Street 1:2499B HIGHWAY 62 412
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:AR
Practice Address - Zip Code:72542-9459
Practice Address - Country:US
Practice Address - Phone:870-856-2718
Practice Address - Fax:870-856-2719
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152601718Medicaid
AR145250718Medicaid
AR5C957Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
AR5W241Medicare ID - Type UnspecifiedMEDICARE PHYSICIAN NUMBER
U37881Medicare UPIN