# LAKESHORE CHIROPRATIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528345923
- **Authorized official:** RUSSELL HY MIONIE D.C. (OWNER)
- **Authorized official phone:** (770) 540-0583

## Contact information

- **Practice address:** 275 PEARL NIX PKWY, SUITE 1, GAINESVILLE, GA 30501-3590
- **Practice address phone:** (770) 532-8200
- **Practice address fax:** (770) 532-9222
- **Mailing address:** 275 PEARL NIX PKWY, SUITE 1, GAINESVILLE, GA 30501-3590
- **Mailing address phone:** (770) 532-8200
- **Mailing address fax:** (770) 532-9222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | CHIR005004 | GA | Yes |

## Other

- **Enumeration date:** 11/14/2011
- **Last updated:** 11/14/2011