Healthcare Provider Details

I. General information

NPI: 1619444015
Provider Name (Legal Business Name): SEBASTIAN LAZAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N CLARK ST STE 602
CHICAGO IL
60610-7848
US

IV. Provider business mailing address

1040 LAKE SHORE BLVD
EVANSTON IL
60202-1433
US

V. Phone/Fax

Practice location:
  • Phone: 312-281-7275
  • Fax:
Mailing address:
  • Phone: 773-699-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: