MEDICARE: LAKESHORE INTEGRATIVE HEALTH CENTER PLLC

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

General Provider Information

NPI Number	:	1083318075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE INTEGRATIVE HEALTH CENTER PLLC

Provider Business Mailing Address
First Line	:	19084 N FRUITPORT RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-1163
Country	:	US
Telephone Number	:	616-846-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	19084 N FRUITPORT RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-1163
Country	:	US
Telephone Number	:	616-846-5410
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL J WEESSIES
Credential	:	DC
Telephone Number	:	616-647-7647

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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