Provider Demographics
NPI:1578822391
Name:STAAB, LUKE J (DC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:J
Last Name:STAAB
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 1:232 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1710
Mailing Address - Country:US
Mailing Address - Phone:308-728-9986
Mailing Address - Fax:308-728-9987
Practice Address - Street 1:232 S 16TH ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1710
Practice Address - Country:US
Practice Address - Phone:308-728-9986
Practice Address - Fax:308-728-9987
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor