Provider Demographics
NPI:1467462564
Name:LUSK, GENE PAUL (D C)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:PAUL
Last Name:LUSK
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S DAVID ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6335
Mailing Address - Country:US
Mailing Address - Phone:325-655-3666
Mailing Address - Fax:325-655-5278
Practice Address - Street 1:225 S DAVID ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6335
Practice Address - Country:US
Practice Address - Phone:325-655-3666
Practice Address - Fax:325-655-5278
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2176111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14519OtherBLK 17A FORM CMS 1500
TXT14519OtherBLK 17A FORM CMS 1500