Provider Demographics
NPI:1629187398
Name:LUECK & MEDINA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LUECK & MEDINA ASSOCIATES, INC.
Other - Org Name:LUECK AND MEDINA ASSOCIATES CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LUECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-397-1900
Mailing Address - Street 1:16 CLEVELAND PL # 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-2533
Mailing Address - Country:US
Mailing Address - Phone:617-742-5214
Mailing Address - Fax:
Practice Address - Street 1:668 SALEM ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4363
Practice Address - Country:US
Practice Address - Phone:781-397-1900
Practice Address - Fax:781-397-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49134Medicare ID - Type UnspecifiedGROUP NUMBER