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General NPI Number Information
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NPI Number | 1659693828
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Entity Type | Individual
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Provider Name | CHRISTOPHER LEE LUECKENOTTE L.M.T
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Gender | Male
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 02/15/2010
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Provider Practice Location Address
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Address Line | 710 S BUSINESS 54
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City | FULTON
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State | MO
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Zip | 65251-1403
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Country | US
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Telephone | 573-642-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 4922 BROOKVIEW DR
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-0215
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Country | US
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Telephone | 573-680-0367
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2006038693
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License Number State | MO
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