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NPI Code Detail

MEDICARE: IDA MARIE HALLGREN-LUKE D.C.

MEDICARE: IDA MARIE HALLGREN-LUKE 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
1111N00000XChiropractor10889CA

General Provider Information

NPI Number : 1700800117
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDA MARIE HALLGREN-LUKE D.C.
Provider Business Mailing Address
First Line : 2 PADRE PKWY STE 105
Second Line :
City : ROHNERT PARK
State : CA
Zip : 94928-2114
Country : US
Telephone Number : 707-795-9698
Fax Number : 707-795-9698
Provider Business Practice Location Address
First Line : 2 PADRE PKWY STE 105
Second Line :
City : ROHNERT PARK
State : CA
Zip : 94928-2114
Country : US
Telephone Number : 707-795-9698
Fax Number : 707-795-9698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 06/14/2023

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