MEDICARE: LIGHTHOUSE CHIROPRACTIC & WELLNESS 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	2301007202	MI

General Provider Information

NPI Number	:	1962607002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE CHIROPRACTIC & WELLNESS CENTER, PLC

Provider Business Mailing Address
First Line	:	1203 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2938
Country	:	US
Telephone Number	:	231-933-1117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2938
Country	:	US
Telephone Number	:	231-933-1117
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KURT D. FROESE
Credential	:	CHIROPRACTIC
Telephone Number	:	231-933-1117

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	04/26/2019

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