Healthcare Provider Details

I. General information

NPI: 1629234356
Provider Name (Legal Business Name): JONATHAN EUGENE LAZAR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S ZEEB RD SUITE 106
ANN ARBOR MI
48103-8326
US

IV. Provider business mailing address

203 S ZEEB RD SUITE 106
ANN ARBOR MI
48103-8326
US

V. Phone/Fax

Practice location:
  • Phone: 734-274-5107
  • Fax: 877-890-6994
Mailing address:
  • Phone: 734-274-5107
  • Fax: 877-890-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009433
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: