Healthcare Provider Details

I. General information

NPI: 1033223284
Provider Name (Legal Business Name): LUCAS JOSEPH SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 HOUPT DR
UPPER SANDUSKY OH
43351-9201
US

IV. Provider business mailing address

109 HOUPT DR
UPPER SANDUSKY OH
43351-9201
US

V. Phone/Fax

Practice location:
  • Phone: 419-294-3489
  • Fax: 419-294-2791
Mailing address:
  • Phone: 419-294-3489
  • Fax: 419-294-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: