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General NPI Number Information
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NPI Number | 1306467907
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Entity Type | Organization
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Legal Business Name | LAKES FAMILY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 16 MINNESOTA AVE W STE 100
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City | GLENWOOD
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State | MN
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Zip | 56334-1558
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Country | US
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Telephone | 320-634-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 16 MINNESOTA AVE W STE 100
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City | GLENWOOD
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State | MN
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Zip | 56334-1558
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Country | US
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Telephone | 320-226-7002
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC
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Name | ADAM DANIEL LOE
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Credential | DC
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Telephone | 320-634-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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