Provider Demographics
NPI:1881689958
Name:ABBAS, LYLE H (DC ACUPUNCTURIST)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:H
Last Name:ABBAS
Suffix:
Gender:M
Credentials:DC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1909
Mailing Address - Country:US
Mailing Address - Phone:641-357-1636
Mailing Address - Fax:
Practice Address - Street 1:211 S 8TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1909
Practice Address - Country:US
Practice Address - Phone:641-357-1636
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA003079Medicaid
IN00307OtherWELLMARK BCBS
IN00307OtherWELLMARK BCBS
003079Medicare ID - Type Unspecified