Provider Demographics
NPI:1376509620
Name:LUCAS, CRAIG JOHN (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOHN
Last Name:LUCAS
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 1:119 THORN APPLE DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2329
Mailing Address - Country:US
Mailing Address - Phone:724-283-0518
Mailing Address - Fax:724-283-8543
Practice Address - Street 1:21626 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-3826
Practice Address - Country:US
Practice Address - Phone:814-226-5441
Practice Address - Fax:814-226-5491
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006468L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA906727OtherHIGHMARK BLUE SHIELD
PA3471582OtherAETNA
PA421826OtherHEALTH AMERICA/HEALTH ASS
PA3471582OtherAETNA
PAU65995Medicare UPIN