Provider Demographics
NPI:1407520067
Name:LAKESIDE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LAKESIDE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-327-3338
Mailing Address - Street 1:1011 JACKSON LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4880
Mailing Address - Country:US
Mailing Address - Phone:843-327-3338
Mailing Address - Fax:
Practice Address - Street 1:101 CHASE CT NW STE D
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7190
Practice Address - Country:US
Practice Address - Phone:843-327-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty