Provider Demographics
NPI:1912032871
Name:LAMAR CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LAMAR CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-538-9880
Mailing Address - Street 1:3520 HUBAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-3379
Mailing Address - Country:US
Mailing Address - Phone:616-538-8810
Mailing Address - Fax:
Practice Address - Street 1:2444 LEE ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2280
Practice Address - Country:US
Practice Address - Phone:616-538-9880
Practice Address - Fax:616-538-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3313582Medicaid
MIT95332Medicare UPIN
MI3313582Medicaid