Healthcare Provider Details

I. General information

NPI: 1962774158
Provider Name (Legal Business Name): LAKEVIEW HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PAUL BUNYAN DR S
BEMIDJI MN
56601-3236
US

IV. Provider business mailing address

118 PAUL BUNYAN DR S
BEMIDJI MN
56601-3236
US

V. Phone/Fax

Practice location:
  • Phone: 218-751-2150
  • Fax:
Mailing address:
  • Phone: 218-444-7788
  • Fax: 218-444-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4040
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4040
License Number StateMN

VIII. Authorized Official

Name: DR. SHAD LEROY SWANSON
Title or Position: OWNER
Credential: D.C.
Phone: 218-444-7788