Healthcare Provider Details

I. General information

NPI: 1619637816
Provider Name (Legal Business Name): LUCAS OSCAR ADOLPH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 07/18/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26406 I45 N SUITE C
SPRING TX
77386
US

IV. Provider business mailing address

26406 I45 N SUITE C
SPRING TX
77386
US

V. Phone/Fax

Practice location:
  • Phone: 281-916-1918
  • Fax:
Mailing address:
  • Phone: 281-916-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14671
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: