Healthcare Provider Details

I. General information

NPI: 1508092404
Provider Name (Legal Business Name): JEANAY HELENE WHYE LUCAS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BELAIR RD
BALTIMORE MD
21213-1257
US

IV. Provider business mailing address

3301 BELAIR RD
BALTIMORE MD
21213-1257
US

V. Phone/Fax

Practice location:
  • Phone: 410-732-6110
  • Fax:
Mailing address:
  • Phone: 410-732-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000661
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS03726
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: