Provider Demographics
NPI:1922558816
Name:LYONS, KEVIN (LAC,)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:424 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4654
Mailing Address - Country:US
Mailing Address - Phone:609-971-3500
Mailing Address - Fax:609-971-3545
Practice Address - Street 1:525 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7737
Practice Address - Country:US
Practice Address - Phone:732-840-1020
Practice Address - Fax:732-865-7787
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00121600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist