Provider Demographics
NPI:1295066272
Name:CYRUS, IAN ANTHONY (LAC)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:ANTHONY
Last Name:CYRUS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:267-342-5880
Mailing Address - Fax:215-955-2509
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-342-5880
Practice Address - Fax:215-955-2509
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000397L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist