Provider Demographics
NPI:1366573651
Name:LYNCH, DANIEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:JOSEPH
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3150 EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1318
Mailing Address - Country:US
Mailing Address - Phone:937-390-6138
Mailing Address - Fax:937-390-6330
Practice Address - Street 1:2685 DERR ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-390-6138
Practice Address - Fax:937-390-6330
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH94803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4480161OtherUHC
OH0523919Medicaid
OH000000013415OtherBCBS
OHLY0523723Medicare ID - Type Unspecified