Provider Demographics
NPI:1184862633
Name:JASON J. TIEL D.C. P.L.L.C.
Entity Type:Organization
Organization Name:JASON J. TIEL D.C. P.L.L.C.
Other - Org Name:LAKESHORE FAMILY CHIROPRACTIC HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-850-0580
Mailing Address - Street 1:510 W SAVIDGE ST
Mailing Address - Street 2:SUITE E.
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-3107
Mailing Address - Country:US
Mailing Address - Phone:616-850-0580
Mailing Address - Fax:616-850-0590
Practice Address - Street 1:510 W SAVIDGE ST
Practice Address - Street 2:SUITE E.
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-3107
Practice Address - Country:US
Practice Address - Phone:616-850-0580
Practice Address - Fax:616-850-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty