Provider Demographics
NPI:1790327518
Name:THURSTON, LUCAS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:JAMES
Last Name:THURSTON
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 1:135 BERTRAND STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781
Mailing Address - Country:US
Mailing Address - Phone:906-643-9940
Mailing Address - Fax:
Practice Address - Street 1:135 BERTRAND STREET
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781
Practice Address - Country:US
Practice Address - Phone:906-643-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor