Provider Demographics
NPI:1033223284
Name:SMITH, LUCAS JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:JOSEPH
Last Name:SMITH
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 1:109 HOUPT DR
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9201
Mailing Address - Country:US
Mailing Address - Phone:419-294-3489
Mailing Address - Fax:419-294-2791
Practice Address - Street 1:109 HOUPT DR
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-9201
Practice Address - Country:US
Practice Address - Phone:419-294-3489
Practice Address - Fax:419-294-2791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2611111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2795097Medicaid
OH5871514OtherAETNA
OH1033223284OtherNPI
OH000000115406OtherBLUE CROSS
SM0837571Medicare ID - Type Unspecified
OH2795097Medicaid
OHU68335Medicare UPIN