Provider Demographics
NPI:1588675441
Name:REDINGTON, LLOYD MICHAEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:MICHAEL
Last Name:REDINGTON
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-0758
Mailing Address - Country:US
Mailing Address - Phone:269-683-0808
Mailing Address - Fax:268-683-6181
Practice Address - Street 1:2224 NILES BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-8923
Practice Address - Country:US
Practice Address - Phone:269-683-0808
Practice Address - Fax:268-683-6181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N25500Medicare ID - Type UnspecifiedMEDICARE #
MIU84042Medicare UPIN