Provider Demographics
NPI:1346945334
Name:LAKE COUNTY CHIROPRACTOR CLINIC INC.
Entity Type:Organization
Organization Name:LAKE COUNTY CHIROPRACTOR CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-644-6247
Mailing Address - Street 1:2149 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2805
Mailing Address - Country:US
Mailing Address - Phone:219-227-9225
Mailing Address - Fax:219-227-9235
Practice Address - Street 1:2149 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2805
Practice Address - Country:US
Practice Address - Phone:219-227-9225
Practice Address - Fax:219-227-9235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center