Provider Demographics
NPI:1164156543
Name:LAKE FOREST INTEGRATED
Entity Type:Organization
Organization Name:LAKE FOREST INTEGRATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-726-1353
Mailing Address - Street 1:840 S WAUKEGAN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2619
Mailing Address - Country:US
Mailing Address - Phone:312-726-1353
Mailing Address - Fax:312-726-5238
Practice Address - Street 1:840 S WAUKEGAN RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2619
Practice Address - Country:US
Practice Address - Phone:312-726-1353
Practice Address - Fax:312-726-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty