Healthcare Provider Details

I. General information

NPI: 1609310044
Provider Name (Legal Business Name): RYAN LAZO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 WESTSIDE BLVD SE
RIO RANCHO NM
87124-4893
US

IV. Provider business mailing address

1920 WESTSIDE BLVD SE
RIO RANCHO NM
87124-4893
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-9444
  • Fax: 505-922-9150
Mailing address:
  • Phone: 505-922-9444
  • Fax: 505-922-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2157
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: