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General NPI Number Information
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NPI Number | 1467653113
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Entity Type | Organization
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Legal Business Name | LAKESHORE CHIROPRACTIC CENTER, P.C.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 1122 LUDINGTON ST
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City | ESCANABA
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State | MI
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Zip | 49829-3540
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Country | US
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Telephone | 906-789-7950
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Fax | 906-789-7951
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Provider Business Mailing Address
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Address Line | 1122 LUDINGTON ST
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City | ESCANABA
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State | MI
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Zip | 49829-3540
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Country | US
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Telephone | 906-789-7950
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Fax | 906-789-7951
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT EDWARD KWARCIANY
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Credential | D.C.
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Telephone | 906-789-7950
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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 | 2301007630
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License Number State | MI
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