Provider Demographics
NPI:1568503035
Name:LUKE, GREGORY E (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:LUKE
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 1:2121 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3610
Mailing Address - Country:US
Mailing Address - Phone:715-398-6679
Mailing Address - Fax:715-398-6080
Practice Address - Street 1:2121 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3610
Practice Address - Country:US
Practice Address - Phone:715-398-6679
Practice Address - Fax:715-398-6080
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38894700Medicaid
WI38894700Medicaid
WI000270440Medicare ID - Type Unspecified