Provider Demographics
NPI:1023212206
Name:LAKELAND CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LAKELAND CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNMICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZZIMENTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-876-1200
Mailing Address - Street 1:704 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1514
Mailing Address - Country:US
Mailing Address - Phone:570-876-1200
Mailing Address - Fax:570-876-4400
Practice Address - Street 1:704 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:PA
Practice Address - Zip Code:18433-1514
Practice Address - Country:US
Practice Address - Phone:570-876-1200
Practice Address - Fax:570-876-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty