Provider Demographics
NPI:1649549296
Name:LUSK CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:LUSK CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-286-8166
Mailing Address - Street 1:1150 US HIGHWAY 51 BYP W
Mailing Address - Street 2:STE A
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1888
Mailing Address - Country:US
Mailing Address - Phone:731-286-8166
Mailing Address - Fax:731-286-1879
Practice Address - Street 1:1150 US HIGHWAY 51 BYP W
Practice Address - Street 2:STE A
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1888
Practice Address - Country:US
Practice Address - Phone:731-286-8166
Practice Address - Fax:731-286-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3678262Medicare PIN
TNU60639Medicare UPIN