MEDICARE: LAKE CITY CHIROPRACTIC OFFICE

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	:	1477302867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE CITY CHIROPRACTIC OFFICE

Provider Business Mailing Address
First Line	:	112 W MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-1604
Country	:	US
Telephone Number	:	712-464-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-1604
Country	:	US
Telephone Number	:	712-464-3149
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANNER SCHRAD
Credential	:	DC
Telephone Number	:	712-464-3149

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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Directions to “LAKE CITY CHIROPRACTIC OFFICE ” Practice Location

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