Provider Demographics
NPI:1457519431
Name:LAKELAND CHIROPRACTIC HEALTH CENTER OF LAKELAND LIMITED
Entity Type:Organization
Organization Name:LAKELAND CHIROPRACTIC HEALTH CENTER OF LAKELAND LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-771-8740
Mailing Address - Street 1:PO BOX 6707
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-0707
Mailing Address - Country:US
Mailing Address - Phone:651-771-8740
Mailing Address - Fax:
Practice Address - Street 1:918 BEECH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-4525
Practice Address - Country:US
Practice Address - Phone:651-771-8740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty