Provider Demographics
NPI:1912173717
Name:LAKEPOINTE CHIROPRACTIC CLINIC, PLC
Entity Type:Organization
Organization Name:LAKEPOINTE CHIROPRACTIC CLINIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDE VEEGAETE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-881-7090
Mailing Address - Street 1:20447 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1660
Mailing Address - Country:US
Mailing Address - Phone:313-881-7090
Mailing Address - Fax:
Practice Address - Street 1:20447 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1660
Practice Address - Country:US
Practice Address - Phone:313-881-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISV2301007247111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM33810Medicare UPIN