1306962196 NPI number — WAYNE A LYSSY, DC PC

Table of content: (NPI 1306962196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306962196 NPI number — WAYNE A LYSSY, DC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE A LYSSY, DC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SARALAND CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306962196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 INDUSTRIAL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARALAND
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36571-3702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-675-5407
Provider Business Mailing Address Fax Number:
251-679-9722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 INDUSTRIAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARALAND
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36571-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-675-5407
Provider Business Practice Location Address Fax Number:
251-679-9722
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LYSSY
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
251-675-5407

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1482 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000098638 . This is a "WAYNE A LYSSY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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