MEDICARE: LAKE EFFECT CHIROPRACTIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1437714755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE EFFECT CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	1210 SALZBURG AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3443
Country	:	US
Telephone Number	:	989-686-6808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 SALZBURG AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3443
Country	:	US
Telephone Number	:	989-686-6808
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	ASHLEY JORDAN
Credential	:	DC
Telephone Number	:	989-545-0929

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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