1922191048 NPI number — LAKEVIEW FAMILY CHIROPRACTORS INC

Table of content: (NPI 1922191048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922191048 NPI number — LAKEVIEW FAMILY CHIROPRACTORS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW FAMILY CHIROPRACTORS INC
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:
TRI COUNTY FAMILY CHIROPRACTORS
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:
1922191048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 649
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEVIEW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48850-0649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-352-8283
Provider Business Mailing Address Fax Number:
989-352-5723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 S LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEVIEW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48850-9178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-352-8283
Provider Business Practice Location Address Fax Number:
989-352-5723
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PADDEN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
GROUP REPRESENTATIVE/OWNER
Authorized Official Telephone Number:
989-352-8283

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1922191048 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145187243 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950E910550 . This is a "BCBSM GROUP ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 145187225 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145187252 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".