GREAT LAKES SPORTS & SPINE LLC NPI 1710768494

NPI Information

NPI: 1710768494
Provider Name: GREAT LAKES SPORTS & SPINE LLC
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
34940 RIDGE RD STE B
WILLOUGHBY, OH
ZIP 44094
Phone: (440) 527-8030
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GREAT LAKES SPORTS & SPINE LLC is a chiropractor in Willoughby, OH. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. GREAT LAKES SPORTS & SPINE LLC NPI is 1710768494. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

34940 RIDGE RD STE B
WILLOUGHBY, OH
ZIP 44094-197
Phone: (440) 527-8030

The provider's authorized official is Matthew Paul Martin .
The authorized official title is Owner/chiropractic Physician and has the following contact phone number (440) 503-6683.

The enumeration date for this NPI number is 10/10/2023 and was last updated on 10/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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