Healthcare Provider Details

I. General information

NPI: 1972827053
Provider Name (Legal Business Name): JULIE BREDETH LUKER L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR S. 510
SAN ANTONIO TX
78229-4849
US

IV. Provider business mailing address

7700 BROADWAY ST S. 104, #127
SAN ANTONIO TX
78209-3232
US

V. Phone/Fax

Practice location:
  • Phone: 210-487-0480
  • Fax:
Mailing address:
  • Phone: 210-487-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: