Provider Demographics
NPI:1184852865
Name:LIGHTHOUSE CHIROPRACTIC
Entity Type:Organization
Organization Name:LIGHTHOUSE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LADUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-314-8311
Mailing Address - Street 1:1527 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1611
Mailing Address - Country:US
Mailing Address - Phone:302-644-1420
Mailing Address - Fax:302-645-0878
Practice Address - Street 1:1527 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1611
Practice Address - Country:US
Practice Address - Phone:302-644-1420
Practice Address - Fax:302-645-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158623Medicare UPIN