Provider Demographics
NPI:1700808607
Name:LAKE ERIE SPINE AND INJURY CENTER
Entity Type:Organization
Organization Name:LAKE ERIE SPINE AND INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-882-4300
Mailing Address - Street 1:1005 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4159
Mailing Address - Country:US
Mailing Address - Phone:814-835-0911
Mailing Address - Fax:814-835-0623
Practice Address - Street 1:1005 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4159
Practice Address - Country:US
Practice Address - Phone:814-835-0911
Practice Address - Fax:814-835-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty