Provider Demographics
NPI:1790090082
Name:SHORELINE CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:SHORELINE CHIROPRACTIC PLC
Other - Org Name:ANCHOR CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DEANE
Authorized Official - Last Name:LENGKEEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-733-1100
Mailing Address - Street 1:3520 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3812
Mailing Address - Country:US
Mailing Address - Phone:231-733-1100
Mailing Address - Fax:231-733-1102
Practice Address - Street 1:3520 GREEN ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3812
Practice Address - Country:US
Practice Address - Phone:231-733-1100
Practice Address - Fax:231-733-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty