Provider Demographics
NPI:1922288612
Name:P.L. LUKOVSKY CHIROPRACTIC CLINIC P.A.
Entity Type:Organization
Organization Name:P.L. LUKOVSKY CHIROPRACTIC CLINIC P.A.
Other - Org Name:LUKOVSKY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-624-5751
Mailing Address - Street 1:5602 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2540
Mailing Address - Country:US
Mailing Address - Phone:218-624-5751
Mailing Address - Fax:218-624-5752
Practice Address - Street 1:5602 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2540
Practice Address - Country:US
Practice Address - Phone:218-624-5751
Practice Address - Fax:218-624-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN69470LUOtherBLUE CROSS BLUE SHIELD
MNC08041OtherMEDICARE