Provider Demographics
NPI:1922595172
Name:KEANE, LUCAS (DC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:KEANE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:KEANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:729 ENZO CT APT 308
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19315 W CATAWBA AVE STE 100
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5637
Practice Address - Country:US
Practice Address - Phone:704-896-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4867111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation