Provider Demographics
NPI:1023039955
Name:LUKOSAVICH, MARC ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANDREW
Last Name:LUKOSAVICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48881 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4405
Mailing Address - Country:US
Mailing Address - Phone:586-532-6373
Mailing Address - Fax:586-532-6372
Practice Address - Street 1:48881 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4405
Practice Address - Country:US
Practice Address - Phone:586-532-6373
Practice Address - Fax:586-532-6372
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20-4336714Medicaid
MIOP29290Medicare ID - Type Unspecified
MIV04123Medicare UPIN