Organization
LAKESIDE CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY B VYROSTEK DC CCSP (CLINIC DIRECTOR)
(814) 382-1970
Entity
Organization
Contact information
Practice address
10633 STATE HIGHWAY 18, CONNEAUT LAKE, PA 16316-3225
(814) 382-1970
(814) 382-3619
Mailing address
10633 STATE HIGHWAY 18, CONNEAUT LAKE, PA 16316-3225
(814) 382-1970
(814) 382-3619
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350056097
PALMETTO GBA
PA
Enumeration date
08/04/2006
Last updated
05/03/2023
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