=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851579866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTORIA DAVIDOVSKY-LUCAS, A PROFESSIONAL CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2008
-----------------------------------------------------
Last Update Date | 12/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 WILSHIRE BLVD STE 204
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90401-1427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-260-9609
-----------------------------------------------------
Fax | 310-260-9519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 WILSHIRE BLVD STE 204
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90401-1427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-260-9609
-----------------------------------------------------
Fax | 310-260-9519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. VICTORIA LUCAS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 310-260-9609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC22227
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------