Provider Demographics
NPI:1184836728
Name:LACERDA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LACERDA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LACERDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-779-3176
Mailing Address - Street 1:17295 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4580
Mailing Address - Country:US
Mailing Address - Phone:408-779-3176
Mailing Address - Fax:408-779-2627
Practice Address - Street 1:17295 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4580
Practice Address - Country:US
Practice Address - Phone:408-779-3176
Practice Address - Fax:408-779-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty