Provider Demographics
NPI:1073213898
Name:LUKENS, PAYTON COLEMAN (DC)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:COLEMAN
Last Name:LUKENS
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 1:1207 CREWS RD STE B
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7582
Mailing Address - Country:US
Mailing Address - Phone:704-246-6111
Mailing Address - Fax:
Practice Address - Street 1:1207 CREWS RD STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7582
Practice Address - Country:US
Practice Address - Phone:704-246-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor