Healthcare Provider Details

I. General information

NPI: 1649673518
Provider Name (Legal Business Name): LACEY EBERT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SW 5TH TER # B
WILLISTON FL
32696-2548
US

IV. Provider business mailing address

5001 SW 20TH ST APT 7001
OCALA FL
34474-8734
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-5433
  • Fax:
Mailing address:
  • Phone: 630-747-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.012684
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: