Provider Demographics
NPI:1942552351
Name:LUCEY, BENJAMIN FREDRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FREDRICK
Last Name:LUCEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 28TH ST SE SUITE H
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6929
Mailing Address - Country:US
Mailing Address - Phone:616-202-7991
Mailing Address - Fax:616-228-8778
Practice Address - Street 1:6504 28TH ST SE
Practice Address - Street 2:SUITE H
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6959
Practice Address - Country:US
Practice Address - Phone:989-390-5799
Practice Address - Fax:616-228-8778
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor