Provider Demographics
NPI:1689753592
Name:MATHEW, LUKSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKSAN
Middle Name:
Last Name:MATHEW
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 1:241 GOLF MILL CENTER
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-699-8888
Mailing Address - Fax:847-699-8830
Practice Address - Street 1:241 GOLF MILL CENTER
Practice Address - Street 2:SUITE 600
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-699-8888
Practice Address - Fax:847-699-8830
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00143017OtherRAILROAD MEDICARE
IL01623055OtherBCBS OF IL
ILP00143017OtherRAILROAD MEDICARE