Provider Demographics
NPI:1083318075
Name:LAKESHORE INTEGRATIVE HEALTH CENTER PLLC
Entity Type:Organization
Organization Name:LAKESHORE INTEGRATIVE HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEESSIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-647-7647
Mailing Address - Street 1:19084 N FRUITPORT RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1163
Mailing Address - Country:US
Mailing Address - Phone:616-846-5410
Mailing Address - Fax:
Practice Address - Street 1:19084 N FRUITPORT RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1163
Practice Address - Country:US
Practice Address - Phone:616-846-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty