Provider Demographics
NPI:1821454448
Name:LAKO, LOTEM LEAH (DC)
Entity Type:Individual
Prefix:DR
First Name:LOTEM
Middle Name:LEAH
Last Name:LAKO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 OLD ALABAMA RD STE 125
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2165
Mailing Address - Country:US
Mailing Address - Phone:770-626-0706
Mailing Address - Fax:
Practice Address - Street 1:1455 OLD ALABAMA RD STE 125
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2165
Practice Address - Country:US
Practice Address - Phone:770-626-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009629111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor