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General NPI Number Information
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NPI Number | 1154593937
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Entity Type | Organization
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Legal Business Name | LAKESIDE SPINE AND WELLNESS LLC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 1800 NE 44TH ST STE 223
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City | RENTON
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State | WA
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Zip | 98056-9035
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Country | US
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Telephone | 206-852-7960
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Fax |
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Provider Business Mailing Address
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Address Line | 2524 CAMAS AVE NE
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City | RENTON
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State | WA
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Zip | 98056-2226
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Country | US
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Telephone | 206-852-7960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW WINGER
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Credential | D.C.
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Telephone | 206-852-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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