Healthcare Provider Details

I. General information

NPI: 1922595172
Provider Name (Legal Business Name): LUCAS KEANE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUKE KEANE DC

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19315 W CATAWBA AVE STE 100
CORNELIUS NC
28031-5637
US

IV. Provider business mailing address

729 ENZO CT APT 308
ROCK HILL SC
29730-0090
US

V. Phone/Fax

Practice location:
  • Phone: 704-896-1811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4867
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4867
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: