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General NPI Number Information
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NPI Number | 1063667152
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Entity Type | Organization
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Legal Business Name | LUCENT CHIROPRACTIC
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 11633 SAN VICENTE BLVD SUITE 214
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-592-7095
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Fax | 310-826-9894
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Provider Business Mailing Address
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Address Line | 11633 SAN VICENTE BLVD SUITE 214
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-592-7095
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Fax | 310-826-9894
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. SERGE C LAZATIN JR.
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Credential | DC
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Telephone | 310-592-7095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | DC30358
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License Number State | CA
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