Provider Demographics
NPI:1013112465
Name:LUSE, MICHAEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:LUSE
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 1:1057 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-6463
Mailing Address - Country:US
Mailing Address - Phone:850-997-5399
Mailing Address - Fax:
Practice Address - Street 1:1102 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2212
Practice Address - Country:US
Practice Address - Phone:850-875-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor