Provider Demographics
NPI:1851543680
Name:LYSNE CHIROPRACTIC CARE S.C.
Entity Type:Organization
Organization Name:LYSNE CHIROPRACTIC CARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:TOLMAN
Authorized Official - Last Name:LYSNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-824-2121
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-0027
Mailing Address - Country:US
Mailing Address - Phone:715-824-2121
Mailing Address - Fax:715-824-2123
Practice Address - Street 1:222 CHRISTY ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:WI
Practice Address - Zip Code:54406-9390
Practice Address - Country:US
Practice Address - Phone:715-824-2121
Practice Address - Fax:715-824-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1281-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT36258Medicare UPIN
WI000075890Medicare PIN