Provider Demographics
NPI:1831583780
Name:ANKENBRUCK, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:ANKENBRUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 EAST LAKEWOOD DRIVE-92
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783
Mailing Address - Country:US
Mailing Address - Phone:260-446-1759
Mailing Address - Fax:
Practice Address - Street 1:7373 E LAKEWOOD DR-92
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-9236
Practice Address - Country:US
Practice Address - Phone:260-446-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer