| NPI | 1033125240 |
|---|---|
| Doing Business As | LAKESIDE SPORTS CHIROPRACTIC CENTER |
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE LIDSTROM Managing Member 704-896-8446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3249) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-05-17 |