Provider Demographics
NPI:1477276558
Name:TERRY, LUKE JEREME (LAC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:JEREME
Last Name:TERRY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:J
Other - Last Name:TERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:ELDORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80025-0394
Mailing Address - Country:US
Mailing Address - Phone:503-757-6484
Mailing Address - Fax:
Practice Address - Street 1:3330 ELDORADO SPRINGS DR # 394
Practice Address - Street 2:
Practice Address - City:ELDORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80025-9900
Practice Address - Country:US
Practice Address - Phone:970-205-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1437171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist