Healthcare Provider Details

I. General information

NPI: 1073233151
Provider Name (Legal Business Name): JOAO LAZARIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 WHEELHOUSE LN STE 1210
LAKE MARY FL
32746-3670
US

IV. Provider business mailing address

564 REED CANAL RD APT 7
SOUTH DAYTONA FL
32119-3263
US

V. Phone/Fax

Practice location:
  • Phone: 407-955-5053
  • Fax:
Mailing address:
  • Phone: 386-212-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH13847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: