| NPI | 1528204922 |
|---|---|
| Doing Business As | LAKESIDE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | ERIK MOLL Medical Director 801-974-3382 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 151129-1205) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 6787397-1202) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2009-01-07 |