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General NPI Number Information
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NPI Number | 1922595172
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Entity Type | Individual
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Provider Name | LUCAS KEANE DC
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Gender | Male
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 19315 W CATAWBA AVE STE 100
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City | CORNELIUS
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State | NC
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Zip | 28031-5637
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Country | US
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Telephone | 704-896-1811
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Fax |
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Provider Business Mailing Address
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Address Line | 729 ENZO CT APT 308
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City | ROCK HILL
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State | SC
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Zip | 29730-0090
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Country | US
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Telephone |
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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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 4867
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4867
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License Number State | NC
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