Provider Demographics
NPI:1689792889
Name:LYNAS, GREGORY TODD (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:TODD
Last Name:LYNAS
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 1:451 COLUMBIA AVE
Mailing Address - Street 2:SUITE E2
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-2228
Mailing Address - Country:US
Mailing Address - Phone:616-399-0110
Mailing Address - Fax:
Practice Address - Street 1:451 COLUMBIA AVE
Practice Address - Street 2:SUITE E2
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2228
Practice Address - Country:US
Practice Address - Phone:616-399-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor