Provider Demographics
NPI:1124377734
Name:SOUTHERLAND, LUCAS DREW (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:DREW
Last Name:SOUTHERLAND
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 1:1092 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:423-748-0506
Mailing Address - Fax:
Practice Address - Street 1:1092 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:423-748-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor