Provider Demographics
NPI:1508332107
Name:LUCAS CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:LUCAS CHIROPRACTIC CLINIC LLC
Other - Org Name:DINO R LUCAS DC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DINO
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-525-2900
Mailing Address - Street 1:903 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3326
Mailing Address - Country:US
Mailing Address - Phone:509-525-2900
Mailing Address - Fax:509-522-9921
Practice Address - Street 1:903 S HOWARD STREET
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3326
Practice Address - Country:US
Practice Address - Phone:509-525-2900
Practice Address - Fax:509-522-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty