Provider Demographics
NPI:1598831125
Name:LUCIER, COLE YOUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:YOUNG
Last Name:LUCIER
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 1:1100 HWY 25 N
Mailing Address - Street 2:STE 4
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313
Mailing Address - Country:US
Mailing Address - Phone:763-682-9779
Mailing Address - Fax:763-682-1179
Practice Address - Street 1:1100 HWY 25 N
Practice Address - Street 2:STE 4
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313
Practice Address - Country:US
Practice Address - Phone:763-682-9779
Practice Address - Fax:763-682-1179
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN392SOLUOtherBCBS
U92534Medicare UPIN