Provider Demographics
NPI:1942318787
Name:BAYLY, LYNN C (DC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:BAYLY
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 1:7563 BROADFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9608
Mailing Address - Country:US
Mailing Address - Phone:315-692-4295
Mailing Address - Fax:315-637-4308
Practice Address - Street 1:7313 HIGHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9779
Practice Address - Country:US
Practice Address - Phone:315-637-2225
Practice Address - Fax:315-637-4308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002484L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102042340001Medicaid
PA196998XN3OtherMEDICARE
PA196998OtherBCBS