MEDICARE: DR. DOUGLAS LU DC, PT, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9318	TX
2	225100000X	Physical Therapist	1169100	TX
3	363LF0000X	Family Nurse Practitioner	AP144579	TX

General Provider Information

NPI Number	:	1013925130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS LU DC, PT, FNP-C

Provider Business Mailing Address
First Line	:	303 E QUINCY ST STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1922
Country	:	US
Telephone Number	:	210-229-7242
Fax Number	:	210-227-5092

Provider Business Practice Location Address
First Line	:	303 E QUINCY ST STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1922
Country	:	US
Telephone Number	:	210-229-7242
Fax Number	:	210-227-5092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/17/2021

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