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General NPI Number Information
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NPI Number | 1700800117
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Entity Type | Individual
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Provider Name | IDA MARIE HALLGREN-LUKE D.C.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 2 PADRE PKWY STE 105
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2114
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Country | US
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Telephone | 707-795-9698
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Fax | 707-795-9698
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Provider Business Mailing Address
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Address Line | 2 PADRE PKWY STE 105
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2114
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Country | US
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Telephone | 707-795-9698
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Fax | 707-795-9698
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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 | 10889
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License Number State | CA
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