LAKE STATE CHIROPRACTIC PLLC
NPI 1215540463
Chiropractor in Byron Center, MI
About Lake State Chiropractic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE STATE CHIROPRACTIC PLLC (NPI 1215540463) is a healthcare organization registered as a chiropractor in Byron Center, Michigan and active in the NPI registry since August 2020. The organization lists Kevin James Sundberg, Owner/doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lake State Chiropractic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lake State Chiropractic PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lake State Chiropractic PLLC's NPI number?
The NPI number for Lake State Chiropractic PLLC is 1215540463. It was assigned to this organization in the NPPES registry on August 27, 2020.
Where is Lake State Chiropractic PLLC located?
Lake State Chiropractic PLLC is located at 2155 84th St SW Ste 4, Byron Center, MI 49315. The listed phone number is (269) 330-0352.
What is Lake State Chiropractic PLLC's specialty?
The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.
Is Lake State Chiropractic PLLC enrolled in Medicare?
Yes. Lake State Chiropractic PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lake State Chiropractic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Lake State Chiropractic PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Lake State Chiropractic PLLC was last updated on August 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lake State Chiropractic Pllc · NPI 1215540463
Chiropractor organization in Byron Center, Michigan. Organization record, active in the CMS NPPES registry since August 27, 2020.
## Identity
- **NPI:** 1215540463 (Entity type: Organization)
- **Enumerated:** August 27, 2020
- **Primary specialty:** Chiropractor · taxonomy 111N00000X
- **Organization subpart:** No
- **Authorized official:** Kevin Sundberg, OWNER/DOCTOR
## Practice location
- **Address:** 2155 84TH ST SW STE 4, Byron Center, MI 49315-8259
- **Phone:** (269) 330-0352
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Chiropractic) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 27, 2020
- **Other identifiers:** Other 1972017481 (MI); Other 2301010620 (MI)
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Source: [NPI Profile](https://npiprofile.com/npi/1215540463) · Data from the CMS NPPES public registry.