Provider Demographics
NPI:1760429393
Name:LAI, ERIC C (DC / LAC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:LAI
Suffix:
Gender:M
Credentials:DC / LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2621
Mailing Address - Country:US
Mailing Address - Phone:626-403-6200
Mailing Address - Fax:626-403-2580
Practice Address - Street 1:1017 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2621
Practice Address - Country:US
Practice Address - Phone:626-403-6200
Practice Address - Fax:626-403-2580
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5654171100000X
CADC 30069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0056540Medicaid