Organization
LAKE MEDICAL CENTER, INC.
Active
Organization
LAKE MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHACK M.D. (PRESIDENT)
(760) 471-2033
Entity
Organization
Contact information
Practice address
1146 SAN MARINO DR, SAN MARCOS, CA 92078-4649
(760) 471-2033
(760) 471-2083
Mailing address
1146 SAN MARINO DR, SAN MARCOS, CA 92078-4649
(760) 471-2033
(760) 471-2083
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC17617
CA
2084N0400X
Neurology Physician
Primary
G26382
CA
Other
Enumeration date
10/15/2007
Last updated
10/15/2007
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