Provider Demographics
NPI:1598817751
Name:LAKEVIEW CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:LAKEVIEW CHIROPRACTIC CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LLOVERAS
Authorized Official - Last Name:HEINTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:281-332-3428
Mailing Address - Street 1:1200 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:281-332-3428
Mailing Address - Fax:281-332-7593
Practice Address - Street 1:1200 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-332-3428
Practice Address - Fax:281-332-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty