Individual
DR. MATTHEW C. LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
505 1ST AVE E, KALISPELL, MT 59901-4939
(406) 755-1117
Mailing address
505 1ST AVE E, KALISPELL, MT 59901-4939
(406) 755-1117
(406) 755-1785
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
899
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41483
BLUE CROSS
MT
Enumeration date
04/20/2007
Last updated
10/05/2010
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