Healthcare Provider Details

I. General information

NPI: 1922324854
Provider Name (Legal Business Name): LAZAR CHIROPRACTIC OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22940 JOAQUIN GULLY ROAD
TWAIN HARTE CA
95383
US

IV. Provider business mailing address

PO BOX 1548 22940 JOAQUIN GULLY RD
TWAIN HARTE CA
95383-1548
US

V. Phone/Fax

Practice location:
  • Phone: 209-586-4441
  • Fax: 209-586-4473
Mailing address:
  • Phone: 209-586-4441
  • Fax: 209-586-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12745
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL SAMMUEL LAZAR
Title or Position: OWNER
Credential: D.C
Phone: 209-586-4441