Provider Demographics
NPI:1962659417
Name:LAKESIDE CHIROPRACTIC CLINIC,P.C.
Entity Type:Organization
Organization Name:LAKESIDE CHIROPRACTIC CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CEANN
Authorized Official - Middle Name:UNDINE
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-687-9299
Mailing Address - Street 1:152 E SAGINAW RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9271
Mailing Address - Country:US
Mailing Address - Phone:989-687-9299
Mailing Address - Fax:989-687-6382
Practice Address - Street 1:152 E SAGINAW RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9271
Practice Address - Country:US
Practice Address - Phone:989-687-9299
Practice Address - Fax:989-687-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty