Provider Demographics
NPI:1740273689
Name:LUKINS, MITCHELL D (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:D
Last Name:LUKINS
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 1:533 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1478
Mailing Address - Country:US
Mailing Address - Phone:810-220-4040
Mailing Address - Fax:
Practice Address - Street 1:533 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1478
Practice Address - Country:US
Practice Address - Phone:810-220-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F328900OtherBCBS OF MI
MI0P16960Medicare ID - Type Unspecified