Provider Demographics
NPI:1790811081
Name:LUCAS, BOBBY A (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:A
Last Name:LUCAS
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 1:1261 S SEWARD MERIDIAN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8334
Mailing Address - Country:US
Mailing Address - Phone:907-357-6100
Mailing Address - Fax:907-357-6102
Practice Address - Street 1:1261 S SEWARD MERIDIAN RD
Practice Address - Street 2:SUITE F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8334
Practice Address - Country:US
Practice Address - Phone:907-357-6100
Practice Address - Fax:907-357-6102
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK89111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK153107Medicare ID - Type Unspecified
AKT67048Medicare UPIN