MEDICARE: DR. JANET M LAKE DC

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	21396	CA

General Provider Information

NPI Number	:	1114211877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET M LAKE DC

Provider Business Mailing Address
First Line	:	363 S INDIAN HILL BLVD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5224
Country	:	US
Telephone Number	:	909-568-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 S INDIAN HILL BLVD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5224
Country	:	US
Telephone Number	:	909-568-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2011
Last Update Date	:	05/30/2011

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