Provider Demographics
NPI:1568855302
Name:LAKEVIEW CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LAKEVIEW CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:NERSESOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-868-7746
Mailing Address - Street 1:2071 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4749
Mailing Address - Country:US
Mailing Address - Phone:516-868-7746
Mailing Address - Fax:516-977-3002
Practice Address - Street 1:2071 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4749
Practice Address - Country:US
Practice Address - Phone:516-868-7746
Practice Address - Fax:516-977-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty