Provider Demographics
NPI:1851579866
Name:VICTORIA DAVIDOVSKY-LUCAS, A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:VICTORIA DAVIDOVSKY-LUCAS, A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-260-9609
Mailing Address - Street 1:530 WILSHIRE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1427
Mailing Address - Country:US
Mailing Address - Phone:310-260-9609
Mailing Address - Fax:310-260-9519
Practice Address - Street 1:530 WILSHIRE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1427
Practice Address - Country:US
Practice Address - Phone:310-260-9609
Practice Address - Fax:310-260-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC22227AMedicare PIN