Provider Demographics
NPI:1629308978
Name:LAKEPOINTE FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LAKEPOINTE FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:SY
Authorized Official - Last Name:MARUSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-924-2547
Mailing Address - Street 1:42000 6 MILE RD
Mailing Address - Street 2:STE 230
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4336
Mailing Address - Country:US
Mailing Address - Phone:248-924-2547
Mailing Address - Fax:248-924-2513
Practice Address - Street 1:42000 6 MILE RD
Practice Address - Street 2:STE 230
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4336
Practice Address - Country:US
Practice Address - Phone:248-924-2547
Practice Address - Fax:248-924-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM008126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H25864OtherBC GRP
MI950H210500OtherBCBSM PROVIDER ID NUMBER
MI0N75020OtherMEDICARE PROVIDER ID NUMBER