Healthcare Provider Details

I. General information

NPI: 1093024895
Provider Name (Legal Business Name): RINCON CHIROPRACTIC, MARSHALL LUCK DC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOWARD ST STE D
SAN FRANCISCO CA
94105-1616
US

IV. Provider business mailing address

101 HOWARD ST STE D
SAN FRANCISCO CA
94105-1616
US

V. Phone/Fax

Practice location:
  • Phone: 415-896-2225
  • Fax:
Mailing address:
  • Phone: 415-896-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC23047
License Number StateCA

VIII. Authorized Official

Name: DR. MARSHALL LUCK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 415-896-2225