Healthcare Provider Details

I. General information

NPI: 1649500174
Provider Name (Legal Business Name): LAKE VIEW FAMILY CHIROPRACTIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 3RD ST
LAKE VIEW IA
51450-7605
US

IV. Provider business mailing address

517 3RD ST
LAKE VIEW IA
51450-7605
US

V. Phone/Fax

Practice location:
  • Phone: 712-657-2225
  • Fax:
Mailing address:
  • Phone: 712-657-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA06123
License Number StateIA

VIII. Authorized Official

Name: DR. JULIE CLAYTON
Title or Position: OWNER
Credential:
Phone: 712-657-2225