Provider Demographics
NPI:1174976898
Name:LAKO FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:LAKO FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOTEM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-626-0706
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:770-383-4656
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:770-383-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty