MEDICARE: DR. LUCCUS LEE WORKMAN D.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	3494	NC

General Provider Information

NPI Number	:	1225133515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCCUS LEE WORKMAN D.C.

Provider Business Mailing Address
First Line	:	5183 CLINTON RD
Second Line	:	SUITE 101
City	:	STEDMAN
State	:	NC
Zip	:	28391-9516
Country	:	US
Telephone Number	:	910-482-4444
Fax Number	:	910-482-4441

Provider Business Practice Location Address
First Line	:	5183 CLINTON RD
Second Line	:	SUITE 101
City	:	STEDMAN
State	:	NC
Zip	:	28391-9516
Country	:	US
Telephone Number	:	910-482-4444
Fax Number	:	910-482-4441

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	10/22/2007

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