Provider Demographics
NPI:1851817670
Name:LUO, LAWRENCE KEKE (DC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:KEKE
Last Name:LUO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:KEKE
Other - Middle Name:
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:300 HENDRICKSON AVE.
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:314-686-8168
Mailing Address - Fax:
Practice Address - Street 1:105-09 JAMAICA AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-441-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor