Provider Demographics
NPI:1750902334
Name:LUCZYNSKI, NATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:LUCZYNSKI
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 1:2519 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2117
Mailing Address - Country:US
Mailing Address - Phone:310-944-5216
Mailing Address - Fax:
Practice Address - Street 1:1603 AVIATION BLVD STE 12
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2856
Practice Address - Country:US
Practice Address - Phone:310-844-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor