Provider Demographics
NPI:1306962196
Name:WAYNE A LYSSY, DC PC
Entity type:Organization
Organization Name:WAYNE A LYSSY, DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LYSSY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-675-5407
Mailing Address - Street 1:112 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3702
Mailing Address - Country:US
Mailing Address - Phone:251-675-5407
Mailing Address - Fax:251-679-9722
Practice Address - Street 1:112 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3702
Practice Address - Country:US
Practice Address - Phone:251-675-5407
Practice Address - Fax:251-679-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000098638OtherWAYNE A LYSSY
ALU42171Medicare UPIN
ALT68356Medicare UPIN
AL000098638OtherWAYNE A LYSSY