Provider Demographics
NPI:1073049490
Name:LAKO, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:LAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1907
Mailing Address - Country:US
Mailing Address - Phone:770-626-0706
Mailing Address - Fax:770-383-4656
Practice Address - Street 1:912 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1907
Practice Address - Country:US
Practice Address - Phone:770-626-0706
Practice Address - Fax:770-383-4656
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor