Provider Demographics
NPI:1710063748
Name:NUNN, LYDELL D (DC)
Entity Type:Individual
Prefix:DR
First Name:LYDELL
Middle Name:D
Last Name:NUNN
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 1:3414 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2621
Mailing Address - Country:US
Mailing Address - Phone:717-755-3899
Mailing Address - Fax:
Practice Address - Street 1:3414 E MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2621
Practice Address - Country:US
Practice Address - Phone:717-755-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03397111N00000X
PADC009704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1982209OtherHIGHMARK BLUE SHIELD
PA112313Medicare PIN