Provider Demographics
NPI:1437927985
Name:LAKESIDE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:LAKESIDE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEYHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-826-7514
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-0834
Mailing Address - Country:US
Mailing Address - Phone:309-826-6970
Mailing Address - Fax:
Practice Address - Street 1:3 CONERY CIR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2338
Practice Address - Country:US
Practice Address - Phone:309-826-7514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty