Provider Demographics
NPI:1942372560
Name:MCGILL, LYNDON LAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:LAYNE
Last Name:MCGILL
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 1:1111 CAYUSE CIR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1397
Mailing Address - Country:US
Mailing Address - Phone:503-931-1315
Mailing Address - Fax:503-362-7250
Practice Address - Street 1:1281 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1959
Practice Address - Country:US
Practice Address - Phone:503-362-5555
Practice Address - Fax:503-362-7250
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67901Medicare UPIN
ORR0000WCKGWMedicare ID - Type Unspecified