Healthcare Provider Details

I. General information

NPI: 1912173717
Provider Name (Legal Business Name): LAKEPOINTE CHIROPRACTIC CLINIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20447 MACK AVE
GROSSE POINTE WOODS MI
48236-1660
US

IV. Provider business mailing address

20447 MACK AVE
GROSSE POINTE WOODS MI
48236-1660
US

V. Phone/Fax

Practice location:
  • Phone: 313-881-7090
  • Fax:
Mailing address:
  • Phone: 313-881-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberSV2301007247
License Number StateMI

VIII. Authorized Official

Name: DR. SCOTT VANDE VEEGAETE
Title or Position: OWNER
Credential: DC
Phone: 313-881-7090