Provider Demographics
NPI:1942524301
Name:WEST LAKE NORMAN CHIROPRACTIC & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:WEST LAKE NORMAN CHIROPRACTIC & WELLNESS CENTER PLLC
Other - Org Name:WEST LAKE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KALKAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-321-0204
Mailing Address - Street 1:105 OAKMONT RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164
Mailing Address - Country:US
Mailing Address - Phone:248-321-0204
Mailing Address - Fax:
Practice Address - Street 1:275 N. HIGHWAY 16
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-489-1999
Practice Address - Fax:704-489-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008364111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION52550Medicaid