Provider Demographics
NPI:1093922478
Name:COLE, LUCAS J (DC)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:J
Last Name:COLE
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:636 LONG POINT RD
Mailing Address - Street 2:UNIT G #101
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8286
Mailing Address - Country:US
Mailing Address - Phone:843-416-8593
Mailing Address - Fax:855-738-7785
Practice Address - Street 1:3404 SALTERBECK ST.
Practice Address - Street 2:# 201
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7119
Practice Address - Country:US
Practice Address - Phone:843-416-8593
Practice Address - Fax:855-738-7785
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
SC3204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3972072Medicare PIN
TNU88043Medicare UPIN
SCAA27158991Medicare PIN