Provider Demographics
NPI:1851157523
Name:LIGHTHOUSE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZICHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-242-3458
Mailing Address - Street 1:2118 N RUBY ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5043
Mailing Address - Country:US
Mailing Address - Phone:509-242-3458
Mailing Address - Fax:
Practice Address - Street 1:2118 N RUBY ST STE E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5043
Practice Address - Country:US
Practice Address - Phone:509-242-3458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty