MEDICARE: LUKAS SPECIFIC CHIROPRACTIC, P.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

General Provider Information

NPI Number	:	1366640534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUKAS SPECIFIC CHIROPRACTIC, P.C

Provider Business Mailing Address
First Line	:	3459 ACWORTH DUE WEST RD NW
Second Line	:	SUITE 410
City	:	ACWORTH
State	:	GA
Zip	:	30101-5819
Country	:	US
Telephone Number	:	770-420-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	3459 ACWORTH DUE WEST RD NW
Second Line	:	SUITE 410
City	:	ACWORTH
State	:	GA
Zip	:	30101-5819
Country	:	US
Telephone Number	:	770-420-2052
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SALVATORE J. LUKAS
Credential	:	D.C
Telephone Number	:	770-420-2052

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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