Healthcare Provider Details

I. General information

NPI: 1700851276
Provider Name (Legal Business Name): TROY LUCKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 S SANTA FE AVE
CHANUTE KS
66720-3206
US

IV. Provider business mailing address

2617 S SANTA FE AVE
CHANUTE KS
66720-3206
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-6513
  • Fax: 620-431-6514
Mailing address:
  • Phone: 620-431-6513
  • Fax: 620-431-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberKS01-04550
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: