MEDICARE: RYAN LAZO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2157	NM

General Provider Information

NPI Number	:	1609310044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LAZO D.C.

Provider Business Mailing Address
First Line	:	1920 WESTSIDE BLVD SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4893
Country	:	US
Telephone Number	:	505-922-9444
Fax Number	:	505-922-9150

Provider Business Practice Location Address
First Line	:	1920 WESTSIDE BLVD SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4893
Country	:	US
Telephone Number	:	505-922-9444
Fax Number	:	505-922-9150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	12/05/2016

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