Provider Demographics
NPI:1841881307
Name:EMMERICH, LUCAS (DC)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:EMMERICH
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 1:1451 BLUESTEM BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2619
Mailing Address - Country:US
Mailing Address - Phone:715-304-3683
Mailing Address - Fax:715-304-3679
Practice Address - Street 1:16301 KENRICK AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8494
Practice Address - Country:US
Practice Address - Phone:952-595-6337
Practice Address - Fax:952-595-6336
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6798111N00000X
WI6143-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor