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NPI Code Detail

MEDICARE: GREAT LAKES FAMILY CHIROPRACTIC CENTER,PC

MEDICARE: GREAT LAKES FAMILY CHIROPRACTIC CENTER,PC
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
1111N00000XChiropractorDC005135LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11394234OTHERPABLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1407024144
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES FAMILY CHIROPRACTIC CENTER,PC
Provider Business Mailing Address
First Line : 1009 E 38TH ST
Second Line :
City : ERIE
State : PA
Zip : 16504-1843
Country : US
Telephone Number : 814-824-6442
Fax Number : 814-824-4007
Provider Business Practice Location Address
First Line : 1009 E 38TH ST
Second Line :
City : ERIE
State : PA
Zip : 16504-1843
Country : US
Telephone Number : 814-824-6442
Fax Number : 814-824-4007
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. LYNNE E HULSE
Credential :
Telephone Number : 814-824-6442
Provider Enumeration Date : 02/15/2008
Last Update Date : 07/08/2008

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Directions to “GREAT LAKES FAMILY CHIROPRACTIC CENTER,PC ” Practice Location

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