Great Lakes Sport and Spine

NPI #1104500925 in Willoughby, Ohio

Provider Information

NPI Number: 1104500925
Entity Type: Organization
Organization Name: Great Lakes Sport and Spine
Primary Specialty: Chiropractor
Enumeration Date: Jun 12, 2023
Last Updated: Jun 12, 2023

Practice Location

Address: 34940 RIDGE RD STE B
City: Willoughby
State: Ohio
ZIP Code: 44094-4197
Phone: (440) 503-6683

Authorized Official

Name: MATTHEW PAUL MARTIN, DC
Title: OWNER
Phone: (440) 503-6683

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Acupuncturist	171100000X
Chiropractor	111N00000X	Primary

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