MEDICARE: LIGHTHOUSE CHIROPRACTIC TOLEDO LLC

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	4346	OH

General Provider Information

NPI Number	:	1538592555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE CHIROPRACTIC TOLEDO LLC

Provider Business Mailing Address
First Line	:	2477 SHORELAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1567
Country	:	US
Telephone Number	:	248-318-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2477 SHORELAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1567
Country	:	US
Telephone Number	:	248-318-5005
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DEANA LAJINESS
Credential	:	D.C.
Telephone Number	:	248-318-5005

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	08/13/2013

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