Provider Demographics
NPI:1003252818
Name:FRASER CENTER OF NATURAL THERAPIES
Entity Type:Organization
Organization Name:FRASER CENTER OF NATURAL THERAPIES
Other - Org Name:LUKOWSKI FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-285-1090
Mailing Address - Street 1:34529 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3576
Mailing Address - Country:US
Mailing Address - Phone:586-285-1090
Mailing Address - Fax:586-285-1099
Practice Address - Street 1:34529 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3576
Practice Address - Country:US
Practice Address - Phone:586-285-1090
Practice Address - Fax:586-285-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6829Medicare PIN
DW4513Medicare PIN