Provider Demographics
NPI:1841348695
Name:LAKEVIEW CHIROPRACTIC INC
Entity type:Organization
Organization Name:LAKEVIEW CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCMATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-982-2700
Mailing Address - Street 1:2100 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2543
Mailing Address - Country:US
Mailing Address - Phone:810-982-2700
Mailing Address - Fax:810-982-5194
Practice Address - Street 1:2100 WATER ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2543
Practice Address - Country:US
Practice Address - Phone:810-982-2700
Practice Address - Fax:810-982-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM006038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBM006038OtherMI LICENSE
MI950G45234OtherBCBS OF MI
MIBM006038OtherMI LICENSE
MI0P29900Medicare PIN
MIU44777Medicare UPIN