Provider Demographics
NPI:1669436754
Name:LUKE, KENNETH E (ATC, LAC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:LUKE
Suffix:
Gender:M
Credentials:ATC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 GRAVENSTEIN HWY N
Mailing Address - Street 2:SUITE 237
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 GRAVENSTEIN HIGHWAY SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:SEBSTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-494-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7331171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist