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General NPI Number Information
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NPI Number | 1558479766
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Entity Type | Individual
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Provider Name | ELLEN M LAZAR D.C.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 42000 6 MILE RD SUITE 230
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City | NORTHVILLE
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State | MI
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Zip | 48168-4336
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Country | US
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Telephone | 248-924-2413
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Fax | 248-924-2513
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Provider Business Mailing Address
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Address Line | 42000 6 MILE RD STE 230 SUITE 230
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City | NORTHVILLE
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State | MI
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Zip | 48168-3412
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Country | US
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Telephone | 248-924-2413
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Fax | 248-924-2513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | EL00005759
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License Number State | MI
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