Provider Demographics
NPI:1770681215
Name:POWNALL, LYNN B (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:B
Last Name:POWNALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6653
Mailing Address - Country:US
Mailing Address - Phone:716-664-5966
Mailing Address - Fax:716-664-7999
Practice Address - Street 1:25 HARRISON ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6653
Practice Address - Country:US
Practice Address - Phone:716-664-5966
Practice Address - Fax:716-664-7999
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006994-1111NN0400X
PADC-004987-L111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020097901OtherUNIVERA PROVIDER NUMBER
NY8809742OtherINDEPENDENT HEALTH
NY161420676-02OtherPRISM HEALTH NETWORKS
NY000211411001OtherBLUE CROSS BLUE SHIELD
NY5802491OtherGHI PROVIDER NUMBER
NY8809742OtherINDEPENDENT HEALTH
NY53468BMedicare ID - Type Unspecified