Provider Demographics
NPI:1710900469
Name:LYDEN, WILLIAM JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:LYDEN
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 1:605 W EDISON RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8823
Mailing Address - Country:US
Mailing Address - Phone:574-258-4444
Mailing Address - Fax:574-258-4445
Practice Address - Street 1:605 W EDISON RD
Practice Address - Street 2:SUITE G
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8823
Practice Address - Country:US
Practice Address - Phone:574-258-4444
Practice Address - Fax:574-258-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002006A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor