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General NPI Number Information
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NPI Number | 1407024144
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Entity Type | Organization
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Legal Business Name | GREAT LAKES FAMILY CHIROPRACTIC CENTER,PC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 1009 E 38TH ST
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City | ERIE
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State | PA
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Zip | 16504-1843
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Country | US
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Telephone | 814-824-6442
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Fax | 814-824-4007
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Provider Business Mailing Address
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Address Line | 1009 E 38TH ST
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City | ERIE
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State | PA
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Zip | 16504-1843
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Country | US
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Telephone | 814-824-6442
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Fax | 814-824-4007
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LYNNE E HULSE
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Credential |
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Telephone | 814-824-6442
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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 | DC005135L
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License Number State | PA
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