Provider Demographics
NPI:1710956057
Name:LAZAROFF, JASON ARI (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ARI
Last Name:LAZAROFF
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 4609
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-0609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4151 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19127-2115
Practice Address - Country:US
Practice Address - Phone:215-482-7246
Practice Address - Fax:215-482-6020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007314L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAJ007314LOtherADJUNCTIVE PHYSIOTHERAPY
PA083799S75Medicare ID - Type UnspecifiedMEDICARE