Provider Demographics
NPI:1568505865
Name:LUECKEN, PETER GRANT (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GRANT
Last Name:LUECKEN
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 1:163 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-728-7720
Mailing Address - Fax:516-489-5855
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-599-6100
Practice Address - Fax:516-593-0400
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0195111N00000X
NYX0108111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor