Healthcare Provider Details

I. General information

NPI: 1316034226
Provider Name (Legal Business Name): KERRY J LAZENBY JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 E M 21
OWOSSO MI
48867-9038
US

IV. Provider business mailing address

1243 E M 21
OWOSSO MI
48867-9038
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-7000
  • Fax: 989-729-0842
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: