Healthcare Provider Details

I. General information

NPI: 1245203868
Provider Name (Legal Business Name): LUCAS J. TUBBS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W 6TH ST
COLBY KS
67701-2300
US

IV. Provider business mailing address

135 W. 6TH
COLBY KS
67701
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-7236
  • Fax: 785-462-2170
Mailing address:
  • Phone: 785-462-7236
  • Fax: 785-462-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4807
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: