Provider Demographics
NPI:1386637502
Name:GUIDRY, DEO LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:DEO
Middle Name:LYNN
Last Name:GUIDRY
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 1:8830 SWANSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6910
Mailing Address - Country:US
Mailing Address - Phone:515-225-8100
Mailing Address - Fax:
Practice Address - Street 1:8830 SWANSON BLVD
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6910
Practice Address - Country:US
Practice Address - Phone:515-225-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6672111N00000X
TX9161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor