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General NPI Number Information
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NPI Number | 1558411074
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Entity Type | Organization
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Legal Business Name | LAKE MOUNTAIN CHIROPRACTIC, INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 1252 WYOMING ST
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City | BOULDER CITY
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State | NV
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Zip | 89005-2745
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Country | US
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Telephone | 702-293-4488
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Fax | 702-293-4487
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Provider Business Mailing Address
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Address Line | 1252 WYOMING ST
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City | BOULDER CITY
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State | NV
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Zip | 89005-2745
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Country | US
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Telephone | 702-293-4488
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Fax | 702-293-4487
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE J. SMITH
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Credential | DC
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Telephone | 702-293-4488
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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 | B00852
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License Number State | NV
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