Provider Demographics
NPI:1942455738
Name:ADVANCED CHIROPRACTIC & REHAB, INC.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC & REHAB, INC.
Other - Org Name:MICHAEL LYONS, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-726-7404
Mailing Address - Street 1:PO BOX 3351
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44513-3351
Mailing Address - Country:US
Mailing Address - Phone:330-726-7404
Mailing Address - Fax:
Practice Address - Street 1:730 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1126
Practice Address - Country:US
Practice Address - Phone:330-726-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2826111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9320182Medicare PIN