24D1017461 CLIA NUMBER - LAKE CITY AMBULANCE SERVICE

Laboratory Demographics

CLIA Number: 24D1017461

Facility Name: LAKE CITY AMBULANCE SERVICE

Facility Address:
601 NORTH 10TH STREET
LAKE CITY, MN
ZIP 55041
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Facility Phone Number: 651 345-3030

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1992879134

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	24D1017461
LAB Type	Ambulance
Facility Name	LAKE CITY AMBULANCE SERVICE
Street	601 NORTH 10TH STREET
City	LAKE CITY
State	MN
ZIP	55041
Phone	651 345-3030
CertificateType	4
CertificateEffectiveDate	9/25/2023
CertificateExpirationDate	9/24/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024