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NPI Code Detail

MEDICARE: LAKE COUNTRY HEALTH CENTER, SC

MEDICARE: LAKE COUNTRY HEALTH CENTER, SC
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
1111N00000XChiropractor2728-12WI

General Provider Information

NPI Number : 1891706123
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE COUNTRY HEALTH CENTER, SC
Provider Business Mailing Address
First Line : 1452 GENESEE ST
Second Line :
City : DELAFIELD
State : WI
Zip : 53018-1432
Country : US
Telephone Number : 262-646-5800
Fax Number : 262-646-5803
Provider Business Practice Location Address
First Line : 1452 GENESEE ST
Second Line :
City : DELAFIELD
State : WI
Zip : 53018-1432
Country : US
Telephone Number : 262-646-5800
Fax Number : 262-646-5803
Authorized Official
Title or Position : OWNER
Name : DR. DANIEL T MURRAY
Credential : D.C.
Telephone Number : 262-646-5800
Provider Enumeration Date : 08/11/2006
Last Update Date : 11/22/2016

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Directions to “LAKE COUNTRY HEALTH CENTER, SC ” Practice Location

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