Provider Demographics
NPI:1114043254
Name:LUKOSAVICH CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:LUKOSAVICH CHIROPRACTIC CENTER PC
Other - Org Name:LUKOSAVICH CHIROPRACTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOROWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUKOSAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-532-6373
Mailing Address - Street 1:48881 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48881 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4405
Practice Address - Country:US
Practice Address - Phone:586-532-6373
Practice Address - Fax:586-532-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E018380OtherBCBS OF MICHIGAN
MIPO29290Medicare ID - Type Unspecified
MIV04123Medicare UPIN