Healthcare Provider Details

I. General information

NPI: 1578635751
Provider Name (Legal Business Name): MICHELE LAZEROW DC, LIC.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PONTIAC ST
OAK BLUFFS MA
02557
US

IV. Provider business mailing address

PO BOX 649
OAK BLUFFS MA
02557-0649
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-2000
  • Fax: 508-693-8526
Mailing address:
  • Phone: 508-693-2000
  • Fax: 508-693-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number70
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number753
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: