Provider Demographics
NPI:1669407359
Name:LYNADY, JOHN R III (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LYNADY
Suffix:III
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 1:250 WAYMONT CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6747
Mailing Address - Country:US
Mailing Address - Phone:407-422-1553
Mailing Address - Fax:
Practice Address - Street 1:250 WAYMONT CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6747
Practice Address - Country:US
Practice Address - Phone:407-422-1553
Practice Address - Fax:407-422-1553
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU76299Medicare UPIN
FLE2884Medicare ID - Type Unspecified