Provider Demographics
NPI:1437456100
Name:LUKOWSKI, RYAN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:LUKOWSKI
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 1:34529 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3576
Mailing Address - Country:US
Mailing Address - Phone:586-285-1090
Mailing Address - Fax:586-439-5794
Practice Address - Street 1:34529 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3576
Practice Address - Country:US
Practice Address - Phone:586-285-1090
Practice Address - Fax:586-439-5794
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6829Medicare PIN
DW4513Medicare PIN