MEDICARE: LAKEWINDS CHIROPRACTIC CENTER PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009090	MI

General Provider Information

NPI Number	:	1043350549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWINDS CHIROPRACTIC CENTER PLC

Provider Business Mailing Address
First Line	:	1877 N GETTY ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49445-8563
Country	:	US
Telephone Number	:	231-744-5200
Fax Number	:	231-744-9484

Provider Business Practice Location Address
First Line	:	1877 N GETTY ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49445-8563
Country	:	US
Telephone Number	:	231-744-5200
Fax Number	:	231-744-9484

Authorized Official
Title or Position	:	MEMBER
Name	:	SANDRA J. MOORE
Credential	:	DC
Telephone Number	:	231-744-5200

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/23/2024

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