Healthcare Provider Details

I. General information

NPI: 1760908313
Provider Name (Legal Business Name): LUCAS GELLIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3464 N LINCOLN AVE
CHICAGO IL
60657-1173
US

IV. Provider business mailing address

1117 EMERSON ST
EVANSTON IL
60201-3131
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-6908
  • Fax:
Mailing address:
  • Phone: 773-348-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: