Provider Demographics
NPI:1922191048
Name:LAKEVIEW FAMILY CHIROPRACTORS INC
Entity Type:Organization
Organization Name:LAKEVIEW FAMILY CHIROPRACTORS INC
Other - Org Name:TRI COUNTY FAMILY CHIROPRACTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP REPRESENTATIVE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-352-8283
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-0649
Mailing Address - Country:US
Mailing Address - Phone:989-352-8283
Mailing Address - Fax:989-352-5723
Practice Address - Street 1:960 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9178
Practice Address - Country:US
Practice Address - Phone:989-352-8283
Practice Address - Fax:989-352-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922191048Medicaid
MI145187243Medicaid
MI950E910550OtherBCBSM GROUP ID
MI145187225Medicaid
MI145187252Medicaid
U42732Medicare UPIN
MI145187225Medicaid
U42733Medicare UPIN