Provider Demographics
NPI:1497819320
Name:LAKEWOOD RANCH CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LAKEWOOD RANCH CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-739-2900
Mailing Address - Street 1:8788 E STATE ROAD 70
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3705
Mailing Address - Country:US
Mailing Address - Phone:941-739-2900
Mailing Address - Fax:941-739-2009
Practice Address - Street 1:8788 E STATE ROAD 70
Practice Address - Street 2:SUITE #101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3705
Practice Address - Country:US
Practice Address - Phone:941-739-2900
Practice Address - Fax:941-739-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty