Provider Demographics
NPI:1952587586
Name:GARDEN LAKES CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GARDEN LAKES CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER OF GAR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAJEUNESSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-877-0156
Mailing Address - Street 1:10720 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 67
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5721
Mailing Address - Country:US
Mailing Address - Phone:623-877-0156
Mailing Address - Fax:623-877-4541
Practice Address - Street 1:10720 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 67
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5721
Practice Address - Country:US
Practice Address - Phone:623-877-0156
Practice Address - Fax:623-877-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11172918OtherCAQH
AZ10659982721OtherUNKNOWN
AZAZ0937460OtherBCBS
AZAW4523OtherUNKNOWN
AZ10659982721OtherUNKNOWN
AZZ72081Medicare Oscar/Certification