Healthcare Provider Details

I. General information

NPI: 1043201148
Provider Name (Legal Business Name): LUCAS J PERNSTEINER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N 1ST ST
HAMILTON MT
59840-2124
US

IV. Provider business mailing address

514 N 1ST ST
HAMILTON MT
59840-2124
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-0237
  • Fax:
Mailing address:
  • Phone: 406-273-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1021
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: