Healthcare Provider Details

I. General information

NPI: 1225133515
Provider Name (Legal Business Name): LUCCUS LEE WORKMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5183 CLINTON RD SUITE 101
STEDMAN NC
28391-9516
US

IV. Provider business mailing address

5183 CLINTON RD SUITE 101
STEDMAN NC
28391-9516
US

V. Phone/Fax

Practice location:
  • Phone: 910-482-4444
  • Fax: 910-482-4441
Mailing address:
  • Phone: 910-482-4444
  • Fax: 910-482-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3494
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: