Provider Demographics
NPI:1619250339
Name:PHIFER, LUCAS (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:PHIFER
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 1:418 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2620
Mailing Address - Country:US
Mailing Address - Phone:805-574-1717
Mailing Address - Fax:
Practice Address - Street 1:415 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2647
Practice Address - Country:US
Practice Address - Phone:805-474-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor