Provider Demographics
NPI:1578786620
Name:JOHN H. FOTI, P.C.
Entity Type:Organization
Organization Name:JOHN H. FOTI, P.C.
Other - Org Name:LIGHTHOUSE CHIROPRACTIC, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FOTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-465-9338
Mailing Address - Street 1:4270 LAKE ST
Mailing Address - Street 2:PO BOX 489
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-0489
Mailing Address - Country:US
Mailing Address - Phone:269-465-9338
Mailing Address - Fax:269-465-9288
Practice Address - Street 1:4270 LAKE ST.
Practice Address - Street 2:BOX 489
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-0489
Practice Address - Country:US
Practice Address - Phone:269-465-9338
Practice Address - Fax:269-465-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P37370Medicare ID - Type Unspecified
MIU74324Medicare UPIN