Provider Demographics
NPI:1598806374
Name:LAKESHORE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LAKESHORE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-842-5100
Mailing Address - Street 1:9745 FALL CREEK RD
Mailing Address - Street 2:STE 700
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4728
Mailing Address - Country:US
Mailing Address - Phone:317-842-5100
Mailing Address - Fax:317-842-5101
Practice Address - Street 1:9745 FALL CREEK RD
Practice Address - Street 2:STE 700
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4728
Practice Address - Country:US
Practice Address - Phone:317-842-5100
Practice Address - Fax:317-842-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201520Medicare PIN