Provider Demographics
NPI:1043201148
Name:PERNSTEINER, LUCAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:J
Last Name:PERNSTEINER
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 1:514 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2124
Mailing Address - Country:US
Mailing Address - Phone:406-273-0237
Mailing Address - Fax:
Practice Address - Street 1:514 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2124
Practice Address - Country:US
Practice Address - Phone:406-273-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000040523OtherBCBS
MT0164021Medicaid
MT000040523OtherBCBS
MT000004498Medicare ID - Type Unspecified