Individual provider Active NPI

Chad Lake, D.C.

  • Chiropractor
  • Grand Ledge, MI
National Provider Identifier
1508859877
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301008249 Issued in MI
Practice address
5680 E Saginaw Hwy
Suite C
Grand Ledge, MI 48837-8102
Phone
(517) 622-8552
Fax
(517) 622-8591
NPI assigned
Aug 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301008249 MI Primary

Addresses

Primary practice location

5680 E Saginaw Hwy
Suite C
Grand Ledge, MI 48837-8102

Mailing address

5680 E Saginaw Hwy
Suite C
Grand Ledge, MI 48837-8102
Phone (517) 622-8552

Other identifiers 1

IdentifierTypeStateIssuer
4320240MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070730000297 MI Practitioner - Chiropractic 6103927579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

914 Charlevoix Dr
Suite 120
Grand Ledge, MI 48837-2280
Phone (517) 622-8552

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301008249MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Chiropractic Center, PLLC Chiropractor CurrentSince Jan 1, 2001 Accepting new patients

Locations

914 Charlevoix Dr
Ste 120
Grand Ledge, MI 48837
Phone (517) 622-8552

914 Charlevoix Dr
Grand Ledge, MI 48837

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1508859877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 E SAGINAW HWY",
            "address_2": "SUITE C",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488378102",
            "telephone_number": "517-622-8552",
            "fax_number": "517-622-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 E SAGINAW HWY",
            "address_2": "SUITE C",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488378102",
            "telephone_number": "517-622-8552",
            "fax_number": "517-622-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "CHAD",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4320240",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Ledge, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.