Organization
LAKE CHIROPRACTIC CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY DAVIS (TREASURER/SECRETARY)
(440) 943-4357
Entity
Organization
Contact information
Practice address
32313 VINE ST, WILLOWICK, OH 44095-3341
(440) 943-4357
(440) 943-5178
Mailing address
32313 VINE ST, WILLOWICK, OH 44095-3341
(440) 943-4357
(440) 943-5178
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1626
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34-19718221-00
OHIO BWC
OH
Enumeration date
10/19/2005
Last updated
08/17/2018
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