Healthcare Provider Details

I. General information

NPI: 1043350549
Provider Name (Legal Business Name): LAKEWINDS CHIROPRACTIC CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 N GETTY ST
MUSKEGON MI
49445-8563
US

IV. Provider business mailing address

1877 N GETTY ST
MUSKEGON MI
49445-8563
US

V. Phone/Fax

Practice location:
  • Phone: 231-744-5200
  • Fax: 231-744-9484
Mailing address:
  • Phone: 231-744-5200
  • Fax: 231-744-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009090
License Number StateMI

VIII. Authorized Official

Name: SANDRA J. MOORE
Title or Position: MEMBER
Credential: DC
Phone: 231-744-5200