Provider Demographics
NPI:1811179781
Name:LAKE CITY CHIROPRACTIC AND MASSAGE
Entity type:Organization
Organization Name:LAKE CITY CHIROPRACTIC AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-752-3877
Mailing Address - Street 1:512 W DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3899
Mailing Address - Country:US
Mailing Address - Phone:386-752-3877
Mailing Address - Fax:386-752-3544
Practice Address - Street 1:512 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3899
Practice Address - Country:US
Practice Address - Phone:386-752-3877
Practice Address - Fax:386-752-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4804Medicare PIN