Provider Demographics
NPI:1659996569
Name:SOLACE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SOLACE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-729-2124
Mailing Address - Street 1:160 PACKETTS LNDG
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1570
Mailing Address - Country:US
Mailing Address - Phone:585-598-3031
Mailing Address - Fax:585-310-0422
Practice Address - Street 1:160 PACKETTS LNDG
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1570
Practice Address - Country:US
Practice Address - Phone:585-598-3031
Practice Address - Fax:585-310-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952434953OtherNPI