Lakeside Chiropractic PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

5129 Issued in AZ

Legal business name

LAKESIDE CHIROPRACTIC PC

Practice address

1640 E Oliver PL
Show Low, AZ 85901-6117

Phone

(928) 532-1225

Fax

(928) 532-2276

NPI assigned

Jan 10, 2008

Last updated

Mar 7, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Richard Albert Boatright, D.C.

Title

President

Phone

(928) 532-1225

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marc A Bauder, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Prescott, AZ
  • NPI 1457314601
  NPD (past)
• Andrea K Kurelowech, DC

  • Chiropractor
  • Phoenix, AZ
  • NPI 1285038547
  NPD (past)
• Gregory Triandafilou, D.C.

  • Chiropractor
  • Phoenix, AZ
  • NPI 1740294917
  NPD (past)

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1417133265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3330",
            "city": "PINETOP",
            "state": "AZ",
            "postal_code": "859353330",
            "telephone_number": "928-532-1225",
            "fax_number": "928-532-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 E OLIVER PL",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859016117",
            "telephone_number": "928-532-1225",
            "fax_number": "928-532-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "BOATRIGHT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-532-1225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "5129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Knippers, MD
• Stephanie M Koch-Prest, RPH
• Richard Marlin Kunkle, LCSW
• Terri Lacey, OT
• Barbara Jo Lacy, R.N.
• Chris A Lambert, LPC
• Larson Chiropractic Inc
• Alyson Larson, PMHNP-BC
• James Wade Larson, D.C.
• Susan Elaine Lasala-Wood, DNP FNP-C, RNFA

• Clinic/Center in Show Low, AZ
• Providers in Show Low, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.