Provider Demographics
NPI:1629391347
Name:BURBRIDGE, LUCAS AUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:AUSTIN
Last Name:BURBRIDGE
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 1:2932 US HIGHWAY 60 E
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-9477
Mailing Address - Country:US
Mailing Address - Phone:816-806-4861
Mailing Address - Fax:
Practice Address - Street 1:2932 US HIGHWAY 60 E
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-9477
Practice Address - Country:US
Practice Address - Phone:816-806-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009021491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor