Provider Demographics
NPI:1770729832
Name:ZERBA, LUCAS D (DC)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:D
Last Name:ZERBA
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 1:100 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2808
Mailing Address - Country:US
Mailing Address - Phone:520-458-3400
Mailing Address - Fax:520-459-8058
Practice Address - Street 1:100 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2808
Practice Address - Country:US
Practice Address - Phone:520-458-3400
Practice Address - Fax:520-459-8058
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139084Medicare PIN