Provider Demographics
NPI:1982882361
Name:MATLOCK, LUCAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:J
Last Name:MATLOCK
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:SEA PLUM TOWN CENTER
Mailing Address - Street 2:2525 MILITARY TRAIL, STE 103
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-746-8482
Mailing Address - Fax:561-746-8452
Practice Address - Street 1:2525 MILITARY TRL
Practice Address - Street 2:STE 103
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7883
Practice Address - Country:US
Practice Address - Phone:561-746-8482
Practice Address - Fax:561-746-8452
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor