Provider Demographics
NPI:1821094004
Name:LYON, BILLY RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:RAY
Last Name:LYON
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 1:7231 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3262
Mailing Address - Country:US
Mailing Address - Phone:909-862-8888
Mailing Address - Fax:909-864-5951
Practice Address - Street 1:7231 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3262
Practice Address - Country:US
Practice Address - Phone:909-862-8888
Practice Address - Fax:909-864-5951
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
CA15692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALY DC0156920OtherBLUE SHIELD
CADC0156920Medicare ID - Type Unspecified