Provider Demographics
NPI:1164651485
Name:LUCICH CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LUCICH CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LUCICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-240-6422
Mailing Address - Street 1:24721 LA PLZ
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2509
Mailing Address - Country:US
Mailing Address - Phone:949-240-6422
Mailing Address - Fax:949-240-6424
Practice Address - Street 1:24721 LA PLZ
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2509
Practice Address - Country:US
Practice Address - Phone:949-240-6422
Practice Address - Fax:949-240-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24483Medicare UPIN