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General NPI Number Information
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NPI Number | 1346639663
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Entity Type | Individual
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Provider Name | LUCAS TODD VANACKER D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 213 MAIN ST STE 106
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City | MASSENA
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State | NY
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Zip | 13662-2905
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Country | US
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Telephone | 315-705-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 24 ST LAWRENCE AVE
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City | WADDINGTON
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State | NY
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Zip | 13694
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Country | US
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Telephone | 585-797-7869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 012619
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License Number State | NY
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