Provider Demographics
NPI:1225541295
Name:EGGERICHS, LUCAS RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:RONALD
Last Name:EGGERICHS
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 1:3910 157TH LN NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-2903
Mailing Address - Country:US
Mailing Address - Phone:763-438-3306
Mailing Address - Fax:
Practice Address - Street 1:14148 LINCOLN ST NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-4651
Practice Address - Country:US
Practice Address - Phone:612-440-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor