Provider Demographics
NPI:1750317590
Name:LYONS, PERRY LYNN (DC)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:LYNN
Last Name:LYONS
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 1:5649 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7145
Mailing Address - Country:US
Mailing Address - Phone:260-436-6565
Mailing Address - Fax:260-459-1130
Practice Address - Street 1:5649 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7145
Practice Address - Country:US
Practice Address - Phone:260-436-6565
Practice Address - Fax:260-459-1130
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100082550AMedicaid
INT25020OtherPIN
IN139740AMedicare ID - Type Unspecified