Provider Demographics
NPI:1437345428
Name:LAKES CENTER FOR CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:LAKES CENTER FOR CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MESKIMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-374-5332
Mailing Address - Street 1:2526 HENNEPIN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3564
Mailing Address - Country:US
Mailing Address - Phone:612-374-5332
Mailing Address - Fax:612-377-4812
Practice Address - Street 1:2526 HENNEPIN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-3564
Practice Address - Country:US
Practice Address - Phone:612-374-5332
Practice Address - Fax:612-377-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3447261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center