Lake Street Pain Relief Center, Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LAKE STREET PAIN RELIEF CENTER, INC

Practice address

515 W Lake St Ste F
Minneapolis, MN 55408-2981

Phone

(612) 827-7246

Fax

(612) 827-8206

NPI assigned

Apr 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Arelis Garcia

Title

Medical Billing Supervisor

Phone

(954) 990-8134

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1104043355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 E LAKE ST STE 101",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071777",
            "telephone_number": "612-827-7246",
            "fax_number": "612-827-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 W LAKE ST STE F",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082981",
            "telephone_number": "612-827-7246",
            "fax_number": "612-827-8206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STREET PAIN RELIEF CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "ARELIS",
        "authorized_official_title_or_position": "MEDICAL BILLING SUPERVISOR",
        "authorized_official_telephone_number": "954-990-8134"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Harriet Operator LLC
• Lake Nicollet Clinic, PA
• Lake Nokomis Home Health Care Inc
• Lake Pointe Chiropractic Centre
• Lake Street Dental
• Lake Transportation Inc
• Lake Victoria Mental Health Services, PC
• John Richard Lake, MD
• Kaitlyn Taylor Lake, MS
• Lakeland Recovery, LLC

• Chiropractor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.