Provider Demographics
NPI:1467653113
Name:LAKESHORE CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:LAKESHORE CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KWARCIANY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-789-7950
Mailing Address - Street 1:1122 LUDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3540
Mailing Address - Country:US
Mailing Address - Phone:906-789-7950
Mailing Address - Fax:906-789-7951
Practice Address - Street 1:1122 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3540
Practice Address - Country:US
Practice Address - Phone:906-789-7950
Practice Address - Fax:906-789-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI69280Medicare UPIN
MI0M59930Medicare ID - Type UnspecifiedMEDICARE PROV.