Provider Demographics
NPI:1689792343
Name:LYNCH, BRIAN P (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:LYNCH
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 1:178 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4224
Mailing Address - Country:US
Mailing Address - Phone:541-258-8151
Mailing Address - Fax:541-259-1626
Practice Address - Street 1:178 PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4224
Practice Address - Country:US
Practice Address - Phone:541-258-8151
Practice Address - Fax:541-259-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00359783OtherRAILROAD MEDICARE I.D.
ORP00359783OtherRAILROAD MEDICARE I.D.