Organization
LAKESHORE INTERVENTIONAL TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN VIGNEAU DC (MEMBER)
(480) 556-9755
Entity
Organization
Contact information
Practice address
4765 S LAKESHORE DR, TEMPE, AZ 85282
(480) 566-9755
Mailing address
4765 S LAKESHORE DR, TEMPE, AZ 85282-7197
(480) 566-9755
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
AZ
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2018
Last updated
02/04/2019
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