Provider Demographics
NPI:1881705218
Name:POWELL, LYNN T (DC)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:T
Last Name:POWELL
Suffix:
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 1:8500 BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7055
Mailing Address - Country:US
Mailing Address - Phone:219-738-1925
Mailing Address - Fax:
Practice Address - Street 1:8500 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7055
Practice Address - Country:US
Practice Address - Phone:219-738-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001720A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN606174OtherACN
IN000000093263OtherBLUE CROSS/BLUE SHIELD
IN7354080OtherAETNA
IN20016660AMedicaid
IN7354080OtherAETNA
INU66428Medicare UPIN