Provider Demographics
NPI:1326656539
Name:LAKE SQUARE CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:LAKE SQUARE CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-326-2481
Mailing Address - Street 1:1010 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6742
Mailing Address - Country:US
Mailing Address - Phone:407-462-5773
Mailing Address - Fax:
Practice Address - Street 1:32629 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3907
Practice Address - Country:US
Practice Address - Phone:352-326-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty