Provider Demographics
NPI:1417222761
Name:LOZITSKY, MICHAEL VASILY (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VASILY
Last Name:LOZITSKY
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 1:7210D BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7972
Mailing Address - Country:US
Mailing Address - Phone:803-732-6635
Mailing Address - Fax:803-461-0655
Practice Address - Street 1:7210D BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7972
Practice Address - Country:US
Practice Address - Phone:803-732-6635
Practice Address - Fax:803-461-0655
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor