Provider Demographics
NPI:1346225687
Name:LEZOTTE, RICHARD A (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:LEZOTTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 COMMERCE PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7967
Mailing Address - Country:US
Mailing Address - Phone:517-668-1300
Mailing Address - Fax:517-669-7227
Practice Address - Street 1:1120 COMMERCE PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7967
Practice Address - Country:US
Practice Address - Phone:517-668-1300
Practice Address - Fax:517-669-7227
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4400042OtherPHP
MI950A950100OtherBCBS
MI4400042OtherPHP
MI950A950100OtherBCBS