Provider Demographics
NPI:1841345584
Name:LAKELAND CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:LAKELAND CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:VINDENI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-697-2455
Mailing Address - Street 1:2969 ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-0156
Mailing Address - Country:US
Mailing Address - Phone:973-697-2455
Mailing Address - Fax:973-697-0800
Practice Address - Street 1:2969 ROUTE 23
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:NJ
Practice Address - Zip Code:07435-0156
Practice Address - Country:US
Practice Address - Phone:973-697-2455
Practice Address - Fax:973-697-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521542Medicare ID - Type UnspecifiedMEDICARE NUMBER