Provider Demographics
NPI:1225235799
Name:HARE, LUCIUS LIDELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCIUS
Middle Name:LIDELLE
Last Name:HARE
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 1:55 MOUSE CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4840
Mailing Address - Country:US
Mailing Address - Phone:423-478-8989
Mailing Address - Fax:423-478-8992
Practice Address - Street 1:55 MOUSE CREEK RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4840
Practice Address - Country:US
Practice Address - Phone:423-478-8989
Practice Address - Fax:423-478-8992
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1514111N00000X
GA2646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730173Medicare PIN
TN103I356004Medicare PIN