Provider Demographics
NPI:1366684359
Name:LAZO, LAURA J (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:LAZO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:FELLOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:112 S OLD STATESVILLE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7803
Mailing Address - Country:US
Mailing Address - Phone:704-992-6622
Mailing Address - Fax:
Practice Address - Street 1:112 S OLD STATESVILLE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7803
Practice Address - Country:US
Practice Address - Phone:704-992-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor