Provider Demographics
NPI:1942366372
Name:CANZANO, LYNN R (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:R
Last Name:CANZANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4802
Mailing Address - Country:US
Mailing Address - Phone:703-481-6004
Mailing Address - Fax:703-481-8944
Practice Address - Street 1:423 CARLISLE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4802
Practice Address - Country:US
Practice Address - Phone:703-481-6004
Practice Address - Fax:703-481-8944
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA453264OtherANTHEM BCBS
VA7378225OtherAETNA
VA7264991OtherCIGNA
VA7378225OtherAETNA
VAG00856Medicare UPIN