Provider Demographics
NPI:1730105982
Name:LYNES, MILTON DOUGLAS (DC)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:DOUGLAS
Last Name:LYNES
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 1:8827 PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002
Mailing Address - Country:US
Mailing Address - Phone:269-324-1449
Mailing Address - Fax:269-323-2970
Practice Address - Street 1:8827 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-324-1449
Practice Address - Fax:269-323-2970
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C950320OtherBCBS
MI0M24860Medicare ID - Type Unspecified
U60913Medicare UPIN