Provider Demographics
NPI:1275030827
Name:LYONS, KIRSTIN AINSLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:AINSLEY
Last Name:LYONS
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 1:200 INDUSTRIAL BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3721
Mailing Address - Country:US
Mailing Address - Phone:706-636-4325
Mailing Address - Fax:
Practice Address - Street 1:200 INDUSTRIAL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3721
Practice Address - Country:US
Practice Address - Phone:706-636-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO010053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor