Provider Demographics
NPI:1447478706
Name:LAKEWOOD CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:LAKEWOOD CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-373-3373
Mailing Address - Street 1:731 NE LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1353
Mailing Address - Country:US
Mailing Address - Phone:816-373-3373
Mailing Address - Fax:816-373-2902
Practice Address - Street 1:731 NE LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1353
Practice Address - Country:US
Practice Address - Phone:816-373-3373
Practice Address - Fax:816-373-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005771111N00000X
MO6124111N00000X
MO2004022004111N00000X, 171100000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU40429Medicare UPIN
MOV05073Medicare UPIN
MOS774223Medicare ID - Type Unspecified
MO157373Medicare UPIN
MOS77D856Medicare ID - Type Unspecified
MOS771581Medicare ID - Type Unspecified