Lake State Chiropractic PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LAKE STATE CHIROPRACTIC PLLC

Practice address

2155 84TH St SW Ste 4
Byron Center, MI 49315-8259

Phone

(269) 330-0352

NPI assigned

Aug 27, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Kevin James Sundberg, D.C.NPI 1972017481

Title

Owner/Doctor

Phone

(269) 330-0352

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Kevin James Sundberg, D.C.

  • Chiropractor
  • Kalamazoo, MI
  • NPI 1972017481
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1598486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1215540463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4463 PENNY LN SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494189383",
            "telephone_number": "269-330-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 84TH ST SW STE 4",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493158259",
            "telephone_number": "269-330-0352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STATE CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-27",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "SUNDBERG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "269-330-0352",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1972017481",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "2301010620",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lakestatechiropractic@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2155 84th St SW Ste 4",
            "city": "Byron Center",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493158259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emma Lynn Koster
• Danielle Kraai, LLPC
• Benjamin Kraft
• Devon Paige Kuiper, PHARMD
• Lyle L. Labardee, LPC
• Dennis John Langland, MA LPC
• Thomas Langton, PA
• Kimberly Lanning
• Franchezka Tiria Lapitan-Moore, PSYD
• Nicole Laplena, PHD

• Chiropractor in Byron Center, MI
• Providers in Byron Center, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; 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.