Lakeside Spine and Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LAKESIDE SPINE AND WELLNESS LLC

Practice address

1800 NE 44TH St Ste 223
Renton, WA 98056-9035

Phone

(206) 852-7960

NPI assigned

Apr 1, 2008

Organization subpart

No

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

Authorized official

Name

Andrew Winger, D.C.NPI 1629035571

Title

Owner

Phone

(206) 852-7960

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Lakeside Spine and Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Michael Winger, D.C.

  • Chiropractor
  • Renton, WA
  • NPI 1629035571
  Medicare reassignment Authorized official
• Juan Pizarro, DC

  • Chiropractor
  • Mobile, AL
  • NPI 1093475089
  NPD
• Michelle L Breese, LMP

  • Massage Therapist
  • Federal Way, WA
  • NPI 1386812469
  NPD (past)
• Christine Dofredo, LMP

  • Massage Therapist
  • Federal Way, WA
  • NPI 1871873166
  NPD (past)
• Jean M Lyon, LMT

  • Massage Therapist
  • Auburn, WA
  • NPI 1215158084
  NPD (past)
• Reggy Nelson, LMP

  • Massage Therapist
  • Federal Way, WA
  • NPI 1215256672
  NPD (past)

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694390400000",
    "number": "1154593937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2524 CAMAS AVE NE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980562226",
            "telephone_number": "206-852-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 NE 44TH ST STE 223",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980569035",
            "telephone_number": "206-852-7960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE SPINE AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A",
        "authorized_official_last_name": "WINGER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-852-7960",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1629035571",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972566529",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1386812469",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Spine and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hiu Yee Lai, BCBA
• Sophia Lai, PHARMD
• Tram Thu Lai
• Yen-Tsun Lai, M.D.
• Randolph Lewis Lake, DDS
• Megan Lally, MSPT
• Ravinder Lally
• Dan Lam, RPH
• Naomi Lam
• Viet Quoc Lam, PHARMD

• Chiropractor in Renton, WA
• Providers in Renton, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.