Organization
LAKE STATE CHIROPRACTIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN JAMES SUNDBERG D.C. (OWNER/DOCTOR)
(269) 330-0352
Entity
Organization
Contact information
Practice address
2155 84TH ST SW STE 4, BYRON CENTER, MI 49315-8259
(269) 330-0352
Mailing address
4463 PENNY LN SW, WYOMING, MI 49418-9383
(269) 330-0352
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972017481
INDIVIDUAL NPI
MI
01
—
2301010620
CHIROPRACTIC LICENSE
MI
Enumeration date
08/27/2020
Last updated
08/27/2020
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