Provider Demographics
NPI:1740388040
Name:LAZARUS, KIMBERLY R (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:ROBIN
Other - Last Name:LAZARUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3851 PIPER ST
Mailing Address - Street 2:SUITE U464
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4684
Mailing Address - Country:US
Mailing Address - Phone:907-339-4800
Mailing Address - Fax:907-339-4801
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:SUITE U464
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4684
Practice Address - Country:US
Practice Address - Phone:907-339-4800
Practice Address - Fax:907-339-4801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK166454Medicare UPIN