Provider Demographics
NPI:1396525002
Name:LAKESHORE CHIROPRACTIC WELLNESS PLLC
Entity type:Organization
Organization Name:LAKESHORE CHIROPRACTIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-208-6039
Mailing Address - Street 1:4711 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3905
Mailing Address - Country:US
Mailing Address - Phone:716-947-5106
Mailing Address - Fax:716-947-9329
Practice Address - Street 1:6778 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9672
Practice Address - Country:US
Practice Address - Phone:716-947-5106
Practice Address - Fax:716-947-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty