Provider Demographics
NPI:1083758239
Name:LUCAS, VERNELL DESHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:VERNELL
Middle Name:DESHAN
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:14051 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-2692
Mailing Address - Country:US
Mailing Address - Phone:562-630-5566
Mailing Address - Fax:562-630-5565
Practice Address - Street 1:14051 PARAMOUNT BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-6153
Practice Address - Country:US
Practice Address - Phone:562-630-5566
Practice Address - Fax:562-630-5565
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA28257111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation