Provider Demographics
NPI:1336560580
Name:LARA, EMIL
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:LARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6913
Mailing Address - Country:US
Mailing Address - Phone:704-405-7000
Mailing Address - Fax:704-405-7001
Practice Address - Street 1:402 E SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6913
Practice Address - Country:US
Practice Address - Phone:704-405-7000
Practice Address - Fax:704-405-7001
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor