=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659168649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONAH EMMANUEL LAZAR DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6208 196TH ST SW STE 103
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-4587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-222-2812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6907 226TH PL SW
-----------------------------------------------------
City | MOUNTLAKE TERRACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98043-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-706-0827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH61621037
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------