Healthcare Provider Details

I. General information

NPI: 1972260453
Provider Name (Legal Business Name): LUCAS JAMES HALLIWELL AND STEPHANIE HALLIWELL CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6332 S TRANSIT RD
LOCKPORT NY
14094-6336
US

IV. Provider business mailing address

61 MONTFORT DR
BUFFALO NY
14225-1337
US

V. Phone/Fax

Practice location:
  • Phone: 716-434-3889
  • Fax:
Mailing address:
  • Phone: 315-877-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LUCAS HALLIWELL
Title or Position: PRESIDENT
Credential: DC
Phone: 315-877-6582