Provider Demographics
NPI:1780877647
Name:LUKE, BRYAN WC (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:WC
Last Name:LUKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1314 S KING ST STE 425
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1939
Mailing Address - Country:US
Mailing Address - Phone:808-591-2400
Mailing Address - Fax:808-589-1408
Practice Address - Street 1:1314 S KING ST STE 425
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1939
Practice Address - Country:US
Practice Address - Phone:808-591-2400
Practice Address - Fax:808-589-1408
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000QCCJPMedicare PIN