Provider Demographics
NPI:1184992760
Name:LYLE R. TIMMONS D.C. PA
Entity type:Organization
Organization Name:LYLE R. TIMMONS D.C. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-726-3452
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:ELLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67637-0019
Mailing Address - Country:US
Mailing Address - Phone:785-726-3452
Mailing Address - Fax:785-726-4007
Practice Address - Street 1:1005 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELLIS
Practice Address - State:KS
Practice Address - Zip Code:67637-1614
Practice Address - Country:US
Practice Address - Phone:785-726-3452
Practice Address - Fax:785-726-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03223111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14846Medicare PIN
KS005407Medicare UPIN