Provider Demographics
NPI:1043340953
Name:LAKE ORION CHIROPRACTIC, PC
Entity type:Organization
Organization Name:LAKE ORION CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:IULIANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-393-1211
Mailing Address - Street 1:2523 SOUTH LAPEER ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2235
Mailing Address - Country:US
Mailing Address - Phone:248-393-1211
Mailing Address - Fax:248-393-1217
Practice Address - Street 1:2523 SOUTH LAPEER ROAD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-2235
Practice Address - Country:US
Practice Address - Phone:248-393-1211
Practice Address - Fax:248-393-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIFI006139OtherBCBS PHYS. ID
MI950F353930OtherBCBS PROV. ID
MIFI006139OtherBCBS PHYS. ID
MI0M27470Medicare ID - Type Unspecified