Provider Demographics
NPI:1245276302
Name:LUTZ, DAVID ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:LUTZ
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 1:3026 SW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4595
Mailing Address - Country:US
Mailing Address - Phone:502-386-9385
Mailing Address - Fax:
Practice Address - Street 1:3326 SW 4TH PLACE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914
Practice Address - Country:US
Practice Address - Phone:502-386-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12511111N00000X
KY4667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2735025000OtherPASSPORT ADVANTAGE
KY50011059OtherPASSPORT
KY85002319Medicaid
KY9989010OtherCIGNA PAL
KYP00428704OtherPALMETTO RAILROAD MEDICARE
KY00025-001Medicare PIN
KY85002319Medicaid