Provider Demographics
NPI:1972827053
Name:LUKER, JULIE BREDETH (L AC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:BREDETH
Last Name:LUKER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 BROADWAY ST
Mailing Address - Street 2:S. 104, #127
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3232
Mailing Address - Country:US
Mailing Address - Phone:210-487-0480
Mailing Address - Fax:
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:S. 510
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4849
Practice Address - Country:US
Practice Address - Phone:210-487-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist