Provider Demographics
NPI:1689784803
Name:LAZAR, MICHAEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:LAZAR
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:PO BOX 1548
Mailing Address - Street 2:22940 JOAQUIN GULLY RD
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-1548
Mailing Address - Country:US
Mailing Address - Phone:209-586-4441
Mailing Address - Fax:209-586-4473
Practice Address - Street 1:22940 JOAQUIN GULLY RD,
Practice Address - Street 2:
Practice Address - City:TWAIN HARTE
Practice Address - State:CA
Practice Address - Zip Code:95383-1548
Practice Address - Country:US
Practice Address - Phone:209-586-4441
Practice Address - Fax:209-586-4473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0127450Medicare ID - Type Unspecified