LAKE STATE CHIROPRACTIC PLLC NPI 1215540463

NPI Information

NPI: 1215540463
Provider Name: LAKE STATE CHIROPRACTIC PLLC
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
2155 84TH ST SW STE 4
BYRON CENTER, MI
ZIP 49315
Phone: (269) 330-0352
Get Directions

LAKE STATE CHIROPRACTIC PLLC is a chiropractor in Byron Center, MI. 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. LAKE STATE CHIROPRACTIC PLLC NPI is 1215540463. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2155 84TH ST SW STE 4
BYRON CENTER, MI
ZIP 49315-259
Phone: (269) 330-0352

The provider's authorized official is Kevin James Sundberg .
The authorized official title is Owner/doctor and has the following contact phone number (269) 330-0352.

The enumeration date for this NPI number is 8/27/2020 and was last updated on 8/27/2020.

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

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1972017481	OTHER	MICHIGAN	INDIVIDUAL NPI
2	2301010620	OTHER	MICHIGAN	CHIROPRACTIC LICENSE

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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