Provider Demographics
NPI:1508978933
Name:LAKESHORE FAMILY CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:LAKESHORE FAMILY CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:RUSHFORD
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-396-6635
Mailing Address - Street 1:244 JAMES ST
Mailing Address - Street 2:STE. B
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2980
Mailing Address - Country:US
Mailing Address - Phone:616-396-6635
Mailing Address - Fax:616-396-6679
Practice Address - Street 1:244 JAMES ST
Practice Address - Street 2:STE. B
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2980
Practice Address - Country:US
Practice Address - Phone:616-396-6635
Practice Address - Fax:616-396-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009161261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center