Provider Demographics
NPI:1912237132
Name:LAKEVIEW CHIROPRACTIC AND WELLNESS CLINIC, S.C.
Entity Type:Organization
Organization Name:LAKEVIEW CHIROPRACTIC AND WELLNESS CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:REINHART
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-880-7175
Mailing Address - Street 1:414 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1218
Mailing Address - Country:US
Mailing Address - Phone:262-637-1822
Mailing Address - Fax:262-637-4522
Practice Address - Street 1:414 SIXTH ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1218
Practice Address - Country:US
Practice Address - Phone:262-637-1822
Practice Address - Fax:262-637-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI455412261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center