Provider Demographics
NPI:1366859761
Name:LAM, IVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:LAM
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 1:20810 CROSS ISLAND PKWY # 528
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1187
Mailing Address - Country:US
Mailing Address - Phone:718-577-8933
Mailing Address - Fax:718-354-8883
Practice Address - Street 1:20935 NORTHERN BLVD STE 209
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3134
Practice Address - Country:US
Practice Address - Phone:718-577-8933
Practice Address - Fax:718-354-8883
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012540-1111N00000X
NY012540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor