Provider Demographics
NPI:1891116851
Name:MARZ, LUCAS
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:MARZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 8TH ST S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5108
Mailing Address - Country:US
Mailing Address - Phone:218-236-1516
Mailing Address - Fax:218-331-0077
Practice Address - Street 1:3505 8TH ST S
Practice Address - Street 2:SUITE 6
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5108
Practice Address - Country:US
Practice Address - Phone:218-236-1516
Practice Address - Fax:218-331-0077
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor