Provider Demographics
NPI:1043350549
Name:LAKEWINDS CHIROPRACTIC CENTER PLC
Entity Type:Organization
Organization Name:LAKEWINDS CHIROPRACTIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-744-5200
Mailing Address - Street 1:1877 N GETTY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-8563
Mailing Address - Country:US
Mailing Address - Phone:231-744-5200
Mailing Address - Fax:231-744-9484
Practice Address - Street 1:1971 HOLTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-1698
Practice Address - Country:US
Practice Address - Phone:231-744-5200
Practice Address - Fax:231-744-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty